Use of invasive and nuclear stress testing in patients with acute ischemiccoronary syndromes in a large, urban, university-affiliate hospital

Background Several recent studies have suggested a high use of invasive pro cedures after acute myocardial infarction, without a corresponding improvem ent in survival. We assessed the relative use of invasive procedures and nu clear cardiac testing during acute coronary syndromes. Methods and Results. We examined the in-hospital utilization rates of invas ive and nuclear stress tests and their association with in-hospital mortali ty in all patients hospitalized with an acute coronary syndrome in a single , university-affiliate hospital for 3 years. The study cohort consisted of 1704 consecutive patients with acute myocardi al infarction and 2414 patients with unstable angina pectoris, The utilizat ion rate of nuclear stress testing was much lower than that of coronary ang iography in patients with either acute myocardial infarction (11.9% vs 73.9 %, P < .001) or unstable angina (8.5% vs. 79.3%, P < .001), Patients examin ed with nuclear stress testing, as compared with patients examined solely b y means of coronary angiography, had lower revascularization and in-hospita l mortality rates, both after acute myocardial infarction (29.2% vs 70%, P < .001, and 1.5% vs 9.6%, P < .001, respectively) and unstable angina (14.6 % vs 80.6%, P < .001, and 1% vs 5.1%, P < .001, respectively), Revasculariz ation guided by means of nuclear stress testing had a lower mortality rate than that performed without the benefit of a nuclear test, both in patients with acute myocardial infarction (0% vs 10.5%) and in patients with unstab le angina (0% vs 5.9%). Conclusion. Noninvasive stress imaging was used much less often than corona ry angiography in patients with acute coronary syndromes, The lower mortali ty rate of patients examined with nuclear stress testing, compared with pat ients examined solely by means of coronary angiography, deserves further st udy, especially in patients undergoing revascularization.