A simple test appears very good at ruling out heart
attacks in people who go to emergency
rooms with chest
pain, a big public health issue and a huge worry for patients.
A large study in Sweden found that the blood test plus the usual
electrocardiogram of the heartbeat were 99% accurate at showing which patients
could safely be sent home rather than be admitted for observation and more
Of nearly 9 000 patients judged low risk by the blood test and with normal
electrocardiograms, only 15 went on to suffer a heart attack in the next month,
and not a single one died.
test may predict heart attack
Admissions may be avoided
"We believe that with this strategy, 20 to 25% of admissions to hospitals
for chest pain may be avoided," said Dr Nadia Bandstein of the Karolinska
University Hospital in Stockholm.
She helped lead the study, published in the Journal of the American
College of Cardiology and presented at the cardiology college's annual
conference in Washington.
Chest pain sends more than 15 million people to emergency rooms in the
United States and Europe each year, and it usually turns out to be due to
anxiety, indigestion or other less-serious things than a heart attack. Yet
doctors don't want to miss one – about 2% of patients having heart attacks are
mistakenly sent home.
People may feel reassured by being admitted to a hospital so doctors can
keep an eye on them, but that raises the risk of picking up an infection and
having expensive care they'll have to pay a share of, plus unnecessary tests.
The study included nearly 15 000 people who went to the Karolinska
University hospital with chest pains over two years. About 8 900 had low scores
on a faster, more sensitive blood test for troponin, a substance that's a sign
of heart damage. The test has been available in Europe, Asia and Canada for
about three years, but it is not yet available in the United States.
A huge waste of resources
The patients were 47 years old on average and 4% had a previous heart attack.
About 21% of them wound up being admitted.
Researchers later looked back to see how the blood test and
electrocardiogram would have predicted how they fared over the next month.
skin patch transmits medical info
They figured that in order to find one heart attack in patients like this,
594 would have to be admitted – a huge waste of resources.
A test like this would be "enormously useful", and the study's
results are "almost too good to be true", said Dr Judd Hollander, an
emergency medicine specialist at the University of Pennsylvania.
He believes the test should be available in the US and that the amount of evidence
that regulators are requiring to approve it is too high.
Dr Allan Jaffe, a cardiologist at the Mayo Clinic, said the problem is not what
the test rules out, but what it might falsely rule in. It's so sensitive that
it can pick up troponin from heart failure and other problems and cause
unnecessary tests for that.
"I think the strategy long-term will be proven," but more studies
underway now in the US are needed to show that, he said.
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