Article

Reason over reflex in acute ischemic syndromes: the case for a rational application of invasive procedures

Journal of Nuclear Cardiology (impact factor: 2.67). 04/2012; 7(4):388-391. DOI:10.1067/mnc.2000.108031 pp.388-391

ABSTRACT The time has come to discard the notion that more invasive is more beneficial for patients with acute ischemic syndromes.
In fact, compelling evidence suggests that just the opposite is true. Overwhelming data indicate that stress nuclear MPI has
a very high sensitivity for detecting patients at risk for future death or MI and can therefore identify very low-risk subgroups
for whom further intervention is decidedly unlikely to benefit and can only add the risk of complications. It is important
to understand that a conservative strategy is not the same as “medical treatment.” A conservative strategy means a rational
evaluation of risk of future cardiac events using a noninvasive approach, reserving revascularization for those patients at
increased risk. It recognizes that nonselective coronary angiography leads to unnecessary revascularization, which can actually
lead to a poorer outcome. Reason over reflex.

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Keywords

acute ischemic syndromes
 
compelling evidence
 
complications
 
conservative strategy
 
detecting patients
 
future cardiac events
 
low-risk subgroups
 
noninvasive approach
 
nonselective coronary angiography
 
Overwhelming data
 
poorer outcome
 
reflex
 
reserving revascularization
 
stress nuclear MPI
 
true
 
unnecessary revascularization
 

Kenneth A. Brown