Noninvasive Functional Imaging Decreases Likelihood of Unnecessary Angiography

Using cardiovascular magnetic resonance (CMR) or myocardial perfusion scintigraphy (MPS) to investigate suspected angina significantly reduced the likelihood unnecessary angiography compared with care directed by National Institute for Health and Care Excellence (NICE) guidelines, which sends high-risk patients directly to angiography. Researchers published their findings in the online JAMA.

“Avoiding unnecessary invasive angiography,” researchers wrote, “could have significant financial benefits, avoids exposing patients to unnecessary risk, and is also a strong patient desire.”

The multicenter Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC 2) trial randomly assigned 1202 symptomatic patients at 6 hospitals in the United Kingdom to management according to NICE guidelines (240) or to guided care based on the results of CMR (481) or MPS testing (481).

Compared with 28.8% of patients who received unnecessary angiography in the NICE guidelines group, just 7.5% of patients in the CMR group and 7.1% in the MPS group received unnecessary angiography, according to the study. The difference between the CMR and MPS groups was not significant

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Rates of major adverse cardiovascular events at 12 months did not differ significantly among any of the groups, researchers reported. The major adverse cardiovascular event (MACE) rate was 1.7% in the NICE guidelines group, compared with 2.5% in the CMR group and 2.5% in the MPS group.

“Overall, rates of disease detection (positive angiography) were comparable for the 3 strategies, suggesting no penalty for using functional imaging as a gatekeeper for angiography, even in high-risk subgroups,” researchers wrote. “Consistent with published studies, the CE-MARC 2 trial showed a low overall rate of MACE in a stable chest pain population, with no early difference between strategies.”—Jolynn Tumolo

Reference

Greenwood JP, Ripley DP, Berry C, et al. Effect of care guided by cardiovascular magnetic resonance, myocardial perfusion scintigraphy, or NICE guidelines on subsequent unnecessary angiography rates [published online August 29, 2016]. JAMA. doi:10.1001/jama.2016.12680