Early heart attacks often treated aggressively
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Patients who come to the emergency department with symptoms suggestive of an impending or “evolving” heart attack are often treated as aggressively as if they had a confirmed one.
The finding comes from the international SYNERGY trial published in a recent release by the European Heart Journal.
“There has always been a concern that patients may be treated less aggressively when they present with heart attack symptoms before laboratory tests are able to confirm the diagnosis,” principal SYNERGY investigator Dr. Chadwick D. Miller of Wake Forest University in Winston-Salem, North Carolina, said in a university release.
Patients in SYNERGY were at least 60 years old and had evidence of a heart attack. Patients were stratified by the results of standard blood test called troponin, which was taken within 12 hours of arrival at the emergency department.
Patients with an immediate positive troponin result were considered to have a heart attack. Those with a negative result, followed by a positive result were considered to have an evolving heart attack. Patients with two successive negative troponin results did not have a heart attack.
There were 1686 patients with evolving heart attack, 5503 with a heart attack and 1120 with no heart attack.
“Physicians appear to treat patients with evolving (heart attacks) with similar medications compared to those with” a confirmed heart attack, Miller told Reuters Health. Therefore, physicians were not delaying treatment based on the negative test results.
As Miller pointed out, “Patients with evolving (heart attacks) had better clinical outcomes (lower rates of death, repeat heart attack) than those with initially positive troponin results. Although the reason for this difference is not entirely clear, these patients were hospitalized and treated earlier in their disease course and thus this could be related to earlier treatment.”
SOURCE: European Heart Journal, April 3rd online 2007.
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