Don't panic at a positive stress test result!

Tuesday, 17 December 2019

A major US study has demonstrated that, for patients with stable heart disease1, invasive procedures such as stents to unblock arteries are no more effective at preventing heart attack and death than medical therapy and lifestyle management alone.

The conclusion from the highly anticipated ISCHEMIA study is that patients don’t always need be rushed to have invasive coronary procedures after an abnormal stress test.

Elliott Antman, an independent Cardiologist at Brigham and Women’s Hospital, Boston said
“The ISCHEMIA trial shows that an early invasive approach does not protect patients against death or the overall chance of a heart attack, but does effectively relieve chest pain — the more chest pain a patient has, the more likely they are to benefit.”

Improvements to heart medicines such as statins has meant that for people who aren’t in the throes of a heart attack, but have stable coronary disease, there is no necessity to undergo invasive procedures with all the additional risks and stresses they involve. For these patients, generally defined as those with clogged arteries, sometimes accompanied by chest pain (angina) on exertion, medication and lifestyle modification can be equally as good an option. However, patients with coronary artery disease who present with unstable angina2 and acute coronary syndrome (ACS)3 still require urgent catheterisation. This may be characterised by sudden pain at rest or at low levels of exertion.

“We want patients to understand that it’s okay to pause and it’s not always urgent that they have a procedure,” said David Maron, director of preventive cardiology at Stanford University, one of the study’s leaders. “It’s important for physicians to understand how symptomatic a patient is — and what is it worth to the patient to go ahead and have a procedure.”

Australians who are concerned about their heart health are advised to talk to their GP about testing and how they can best manage their symptoms.

1Stable heart disease is often characterised by stable angina. This may be defined as episodes of chest pain/discomfort that are brought on by stress or exertion, are brief in duration and occur predictably. Stable angina does not typically change in frequency or severity. It does not worsen over time and has been occurring unchanged for more than a month.

2Unstable angina is chest pain that occurs at rest, with exertion, stress, or awakens you from sleep. The pain worsens in frequency and severity.  An attack of unstable angina is an emergency and you should seek immediate medical treatment. If left untreated, unstable angina can lead to heart attack, heart failure, or arrhythmias (irregular heart rhythms). These can be life-threatening conditions.

3Acute coronary syndrome (ACS) defines a range of conditions associated with sudden, reduced blood flow to the heart.  It includes unstable angina where there is a high risk of a heart attack.  ACS also includes a heart attack (myocardial infarction) where the heart muscle is damaged.  ACS often causes severe chest discomfort or pain.  It requires immediate medical attention and hospitalisation and commonly requires measures to improve blood flow to the heart (coronary stenting or bypass graft surgery).