Evidence map›Paper›PMID 40196978›Full record

ArticleAnnals of emergency medicine2025

Association of Early Noninvasive Cardiac Stress Testing With Acute Myocardial Infarction and Mortality.

Aniket A Kawatkar, Aileen S Baecker, Adam L Sharp, Rita F Redberg, Ming-Sum Lee, Maros Ferencik, Steve Goodacre, Praveen Thokala, Yi-Lin Wu, Chengyi Zheng and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Aniket A KawatkarDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA; Bernard J. Tyson School of Medicine, Kaiser Permanente, Pasadena, CA. Electronic address: aniket.a.kawatkar@kp.org.
Aileen S BaeckerDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Adam L SharpDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA; Bernard J. Tyson School of Medicine, Kaiser Permanente, Pasadena, CA.
Rita F RedbergDivision of Cardiology, University of California, San Francisco, San Francisco, CA.
Ming-Sum LeeDivision of Cardiology, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA.
Maros FerencikKnight Cardiovascular Institute, Oregon Health and Science University, Portland, OR.
Steve GoodacreSchool of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, Regent Street, Sheffield, United Kingdom.
Praveen ThokalaSchool of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, Regent Street, Sheffield, United Kingdom.
Yi-Lin WuDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Chengyi ZhengDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Ernest ShenDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Benjamin C SunDepartment of Emergency Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.

Funding

Comparative Effectiveness of Early Diagnostic and Disposition Strategies for Suspected Acute Coronary SyndromeR01HL134647 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI SUN, BENJAMIN C · 2017 to 2020
$3.1M
NHLBI NIH HHS R01 HL134647
6 · The paper itself

Abstract

STUDY

objectiveThe evaluation for suspected acute coronary syndrome is a common and high-risk presentation in emergency departments (EDs). After exclusion of acute myocardial infarction (MI), patients often undergo early (within 72 hours) noninvasive cardiac testing. We evaluated the association between early noninvasive testing and death/acute MI in ED patients suspected of acute coronary syndrome.

methodsWe used a retrospective cohort study design within the adult ED patient population (from October 2015 to December 2020) in whom MI was ruled out, belonging to a large integrated health care delivery system. Using data on history (H), electrocardiogram (E), age (A), risk factors (R), and troponin (T), we computed the HEART risk score. We stratified the cohort into low (score 0 to 3), intermediate (score 4 to 6), and high (score ≥7) risk and followed them up to 1-year after ED discharge. The association between noninvasive testing within 3 days of the ED visit and composite risk of death/acute MI within 1-year of discharge was evaluated by propensity score analysis.

resultsThe cohort included 174,917 patients (61% low risk [age 53; women 58%; noninvasive testing 5%], 36% intermediate risk [age 71; women 52%; noninvasive testing 18%], and 3% high risk [age 74, women 45%; noninvasive testing 23%]). The risk reduction in death/acute MI associated with early noninvasive testing was -1.54% (-1.95% to -1.12%) number needed to treat (NNT)=65; -4.93% (-5.66% to -4.20%) NNT=20, and -8.98% (95% confidence interval -11.32% to -6.64%) NNT=11; and, in the low, intermediate, and high-risk respectively.

conclusionEarly noninvasive testing was associated with reduced risk of 1-year death or acute MI across all risk groups.

Indexed as

Acute Coronary SyndromeExercise TestMyocardial InfarctionAdultAgedElectrocardiographyEmergency Service, HospitalFemaleHumansMaleMiddle AgedPropensity ScoreRetrospective StudiesRisk AssessmentRisk FactorsAcute coronary syndromeExercise testHeart disease risk factorsRisk assessment

Identifiers

PMID40196978
PMCPMC12354101

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.