Early transthoracic echocardiography performed within 72 hours of hospitalization for acute myocardial infarction was associated with a small reduction in mortality but a notable increase in major cardiovascular events, according to a large retrospective analysis of 352,920 patients.
The research, conducted by Shivam Singh, MD, and colleagues, was chosen as a 2025 Arthur E. Weyman Young Investigator’s Award Competition Finalist. Findings were presented at the American Society of Echocardiography 2025 annual meeting and as an abstract in the Journal of the American Society of Echocardiography.
Patients who underwent early transthoracic echocardiography (TTE) had a 21% mortality rate compared with 22.4% in those without early imaging. However, major cardiovascular events (MACE) occurred more frequently in the early imaging group at 65.9% versus 59.4%.
Kaplan-Meier analysis showed only a slight survival advantage for early TTE patients compared to controls (52% vs 51%) over approximately 4,000 days of follow-up, while MACE-free survival diverged earlier and more sharply, reflecting a higher complication burden in the early imaging group.
"While inpatient TTE aids clinical management in select cases, certain stable AMI [acute myocardial infarction] patients may safely defer imaging to the outpatient setting," noted Dr. Singh, of the Mayo Clinic in Rochester, MN, and colleagues.
The investigation utilized electronic medical records from 68 healthcare organizations through the TriNetX US Collaborative Network, focusing on low-risk AMI patients and excluding those with cardiogenic shock or cardiac arrest. Propensity score matching produced two balanced cohorts of 176,460 patients each.
The primary outcomes measured were all-cause mortality and MACE, defined as recurrent myocardial infarction, stroke, heart failure, and ventricular tachycardia.
Mean age was 67.8 years in the early TTE group and 67.5 years in controls; men comprised 55.3% and 55.6% of each group, respectively, with no significant difference. Racial distribution remained similar between groups, with white patients representing 68.8% the early TTE group versus 68.6% in controls.
The study's methodology addressed potential confounding through comprehensive propensity score matching, accounting for demographic variables, comorbidities, medications, and laboratory parameters. Statistical significance was established, with comparative analyses including risk differences, survival estimates, and hazard ratios.
"Limited data suggest that hospitals with high inpatient TTE utilization post-MI incur greater hospital costs and longer lengths of stay," the researchers noted. "However, the impact of TTE timing—whether performed during hospitalization or in an outpatient setting—on MI-related outcomes remains unclear."
They added that "further research is needed to refine patient selection and optimize resource utilization."
Disclosures were not made available at press time.