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When Chest Pain Requires Quick Action in ER

Half were randomly assigned to get early assessment of coronary artery blockage followed by an artery-opening procedure if necessary -- on average, within 14 hours -- and the other half waited an average of 50 hours for such treatment. After six months, the incidence of death, heart attacks or stroke wasn't that different in the two groups -- 9.6 percent of those who had early intervention, 11.3 percent among those who waited.

But analysis of the results showed that the benefit was concentrated among those people who were graded as being at highest risk on a scale that included such factors as age, blood pressure and presence of biomarkers of heart injury. So the bottom line, Mehta said, is that "it is OK to wait unless you are at high risk."

The finding is useful in several practical ways, he said. For one, it helps settle a debate about whether early intervention might be harmful in some cases. "The study showed that early intervention does not increase the risk," Mehta said.

And then the findings can be applied to the not uncommon scenario when emergency department doctors have to deal with acute coronary syndrome at an awkward time or place -- late on Friday in a busy city hospital, for example.

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Pat Elliott

Heart & Blood Guide