CAN CARDIAC MRI STRESS TESTING REDUCE HEALTHCARE COSTS OF CARDIAC ISCHEMIC EVALUATION?
Annually, over 1 million invasive coronary arteriography (CATH) procedures are performed in the US (Mozaffarian et al. Circulation. 2016 133(4):e38-360). Patel et al (N Engl J Med. 2010 362(10):886-95) showed that less than 50% of nuclear stress myocardial perfusion imaging (MPI) studies correlate with subsequent CATH, due to a high false positive rate. Yet, the landmark CE-MARC trial (Lancet 2012;379:453-60) showed that cardiac magnetic resonance stress imaging (CMR stress) had greater sensitivity than MPI in patients with coronary artery disease (CAD). The study was designed to determine whether CMR stress could be a cost-reducing alternative to CATH after an abnormal MPI.
An institutional imaging database was queried for all patients who had a normal CMR stress within six months after an abnormal MPI. Fifty-three patients met the criteria for this study. The number of CATHs and invasive coronary procedures (CABG and PCI) were tabulated over a 2.5-year follow-up period, along with clinical outcomes.
Yendamuri R; Kuraan T; Yim M; Mikolich B; Mikolich JR
Journal Of The American College Of Cardiology
2021
2021-05-11
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Journal Article
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Retrospective Comparison of Cardiac Testing and Results on Inpatients with Low Pretest Probability Compared with Moderate/High Pretest Probability for Coronary Artery Disease.
Coronary Artery Disease; Pretest Probability; Stress Test
OBJECTIVE: To determine whether admission, and provocative stress testing of patients who have ruled out for acute coronary syndrome put patients with low-risk category for coronary artery disease (CAD) at risk for false-positive provocative stress testing and unnecessary coronary angiogram/imaging. METHODS: A retrospective chart review was performed on patients between 30 and 70 years old, with no pre-existing diagnosis of CAD, admitted to observation or inpatient status chest pain or related complaints. Included patients were categorized based on Duke Clinical Score for pretest probability for CAD into either low-risk group, or moderate/high-risk group. The inpatient course was compared including whether provocative stress testing was performed; results of stress testing; whether patients underwent further coronary imaging; and what the results of the further imaging showed. RESULTS: 543 patients were eligible: 305 low pretest probability, and 238 moderate/high pretest probability. No difference was found in rate of stress testing relative risk (RR) = 1.01 (95% CI, 0.852 to 1.192; P = 0); rate of positive or equivocal stress tests between the 2 groups: RR = 0.653 (95% CI, 0.415 to 1.028; P = .07,). Low-pretest-probability patients had a lower likelihood of positive coronary imaging after stress test, RR = 0.061 (95% CI, 0.004 to 0.957; P = .001). CONCLUSION: Follow-up provocative testing of all patients admitted/observed after emergency department presentation with chest pain is unlikely to find CAD in patients with low pretest probability. Testing all low-probability patients puts them at increased risk for unnecessary invasive confirmatory testing. Further prospective testing is needed to confirm these retrospective results.
Lear Aaron; Huber Merritt; Canada Amy; Robertson Jessica; Bosman Evan; Zyzanski Stephen
Journal of the American Board of Family Medicine : JABFM
2018
2018-04
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<a href="http://doi.org/10.3122/jabfm.2018.02.170295" target="_blank" rel="noreferrer noopener">10.3122/jabfm.2018.02.170295</a>