Cardiology Corner - ACS State of the Art – Evocative Testing

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Bridget S. -

Here is my question about evocative testing: how does the testing actually change outcomes? Even without further testing, patients who undergo chest pain evaluation should be encouraged to live a healthy lifestyle (exercise, diet, quit smoking) and get hypertension, diabetes, high cholesterol treated, maybe take an aspirin. Add to this beta blockers, maybe double the anti-platelet therapy and add statins in a patient who has already had an MI. These are long-term interventions that can be implemented in the outpatient setting.
My understanding is that more invasive therapy in patients who are not having a heart attack, such as PCI or CABG, doesn't actually save lives or prevent MI, but those are the interventions I imagine are increased if you perform evocative testing after all chest pain workups.
Bottom line: even if I have a patient who is high risk for a heart attack in the next 30 days, what good is further cardiac testing going to do for my patient once I've ruled out an MI, especially if they can get good primary care follow-up?

Amal M., M.D. -

Bridget,
There might be some confusion here about how and when stress testing is useful.
The studies comparing routine stress testing with subsequent invasive procedures vs. conservative treatment (diet, exercise, and medicines only) in Asymptomatic, stable patients have really not shown a mortality difference. But in this discussion, we are largely talking about symptomatic patients. Patients that are symptomatic with positive stress tests will do better with more aggressive therapy such as cath --> stent or PTCA, vs. just medical therapy.

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