Photo Credit: pokerhead

The following is a summary of “Association of Early Noninvasive Cardiac Stress Testing With Acute Myocardial Infarction and Mortality,” published in the April 2025 issue of Annals of Emergency Medicine by Kawatkar et al. 

Researchers conducted a retrospective study to examine the association between early noninvasive cardiac testing and the occurrence of death or acute myocardial infarction (MI) in individuals seeking emergency care for suspected acute coronary syndrome, who did not initially receive a diagnosis of MI. 

They analyzed data from adults in the ED population (from October 2015 to December 2020) where MI had been ruled out in a large integrated health care delivery system. Using history (H), electrocardiogram (E), age (A), risk factors (R), and troponin (T), and calculated the HEART risk score. The cohort was categorized into low (score 0 to 3), intermediate (score 4 to 6), and high (score ≥7) risk groups and monitored for up to 1 year after ED discharge. Propensity score analysis determined the association between noninvasive testing within 3 days of the ED visit and the composite risk of death or acute MI within 1 year.  

The results showed that 1,74,936 individuals were included (61% low risk [age 53; women 58%; noninvasive testing 5%], 36% intermediate risk [age 71; women 52%; noninvasive testing 18%], and 3% high risk [age 74; women 45%; noninvasive testing 23%]). Early noninvasive testing was associated with a reduction in death or acute MI of −1.54% (−1.95% to −1.12%) number needed to treat (NNT)=65 in the low-risk group, −4.93% (−5.66% to −4.20%) NNT=20 in the intermediate-risk group, and −8.98% (95% CI -11.32% to −6.64%) NNT=11 in the high-risk group.  

Investigators concluded that early noninvasive testing was associated with a reduced risk of death or acute MI at 1 year across all risk groups. 

Source: annemergmed.com/article/S0196-0644(25)00119-2/abstract