Early cardiac stress testing

NEW YORK (Reuters Health) - In selected cardiac patients, stress testing can be performed safely in the first 2 to 3 days after admission for unstable angina or non-ST elevation myocardial infarction following treatment with aspirin, heparin and tirofiban.
In the December 15th issue of the American Journal of Cardiology, Dr. Juhana Karha of the Cleveland Clinic Foundation in Ohio and colleagues evaluated stress testing performed in participants in two multicenter studies. These included the Treat Angina with aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy -- Thrombolysis In Myocardial Infarction (TACTICS-TIMI) 18 trial, and the TIMI 3B trial.
According to the article, both trials randomized patients to early invasive treatment or to a conservative strategy. In the conservative strategies, catheterization was performed only if ischemia recurred or if a stress test performed within 48-72 hours of admission was abnormal (the TACTICS-TIMI 18 trial); or stress testing was done 4 to 5 days after admission (the TIMI 3B trial).
All patients described in the report were drawn from the conservative arms of these two trials. A total of 847 patients underwent stress testing.
The researchers report that patients in the TACTICS-TIMI 18 study received more aggressive therapy, including treatment with tirofiban, a platelet glycoprotein IIb/IIIa inhibitor, compared with the TIMI 3B subjects.
The morality rate in the TACTICS trial was 0.12%. The complication rate was similar in the conservative arm of both trials, the investigators note.
"Thus," they add, "in the setting of augmented antiplatelet therapy, earlier stress testing carried a similar risk of complications."
Based on their findings, the researchers conclude, in patients such as those in their analysis, "performance of an exercise or pharmacologic stress test...within 48 to 72 hours after admission appears to be associated with a low risk of complications."
Am J Cardiol 2004;94:1537-1539


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