Functional imaging reduces unnecessary angiography for suspected heart disease

By John Murphy, MDLinx
Published August 30, 2016

Key Takeaways

In patients with suspected coronary heart disease (CHD), management guided by functional imaging resulted in significantly fewer unnecessary angiographies compared with management directed by national guidelines, according to results presented August 29, 2016 at the European Society of Cardiology Congress, held in Rome. The study was published simultaneously in the Journal of the American Medical Association.

“Rates of invasive angiography are considered too high among patients with suspected coronary heart disease,” said lead investigator John Greenwood, PhD, Professor of Cardiology and Consultant Cardiologist at the University of Leeds, in Leeds, UK. “Reducing unnecessary angiography should reduce patient risk and provide significant financial savings.”

Despite widespread recommendations for non-invasive imaging, invasive coronary angiography is still commonly used as a first-line strategy for diagnosing patients with suspected CHD, Dr. Greenwood explained. However, results of large studies of patients who present with chest pain have shown that the majority of these patients do not have obstructive coronary disease.

For this study—the Clinical Evaluation of MAgnetic Resonance imaging in Coronary heart disease 2 (CE-MARC 2) trial—Dr. Greenwood and colleagues at six centers in the UK enrolled 1,202 patients with suspected CHD, all of whom reported chest pain as their primary symptom.

The researchers randomly assigned patients to management directed by the UK's National Institute for Health and Care Excellence (NICE) guidelines or to functional imaging-guided care based on the results of cardiovascular magnetic resonance (CMR) imaging or myocardial perfusion scintigraphy (MPS) testing.

After 12 months, a total of 265 patients underwent at least one coronary angiogram: 102 of 240 patients (42.5%) in the NICE guidelines group, 85 of 481 patients (17.7%) in the CMR group, and 78 of 481 patients (16.2%) in the MPS group. There were no statistically significant differences between the three patient groups in their rates of major adverse cardiovascular events.

“Our findings show that both CMR and MPS significantly reduced rates of unnecessary angiography compared to guideline-directed care, with no penalty in terms of major adverse cardiovascular events,” Dr. Greenwood said. “This suggests that functional imaging should be adopted on a wider basis, even in high-risk patient subgroups.”

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