U.K. PCI study sparks U.S. debate
On Wednesday, November 1, results from the Objective Randomized Blinded Investigation with Optimal Medical Therapy of Angioplasty in Stable Angina (ORBITA) study were published in The Lancet.
The next day, this article was published in the New York Times:
"A procedure used to relieve chest pain in hundreds of thousands of heart patients each year is useless for many of them," it began... "The new study, published in the Lancet, stunned leading cardiologists by countering decades of clinical experience. The findings raise questions about whether stents should be used so often—or at all—to treat chest pain."
Without further knowledge, the debate may start right here—the New York Times article had little in the way of medical detail to satisfy invasive cardiovascular professionals and may have further generalized results in a misleading manner.
But let's hold off on reacting, look at the debate surrounding this particular study and also place the findings in a wider context (part two). Note: this isn't the first time it has been suggested that stents are overused.
Continue reading Stents not effective? Study sparks debate pt. 1
Results from the CE-MARC 2 trial, announced today at the European Society of Cardiology (ESC) Congress, suggest that unnecessary angiography could be significantly reduced by favoring noninvasive cardiovascular magnetic resonance (CMR) imaging or single photon emission computed tomography (SPECT) to initially investigate patients with suspected coronary artery disease (CAD).
These findings could have an "important impact on referral rates for invasive coronary angiography," says the ESC press release.
Continue reading Broader CMR or SPECT imaging reduces unnecessary angiography
"Exercise stress electrocardiography (ExECG) is underutilized as the initial test modality in patients with interpretable electrocardiograms who are able to exercise. Although stress myocardial imaging techniques provide valuable diagnostic and prognostic information, variables derived from ExECG can yield substantial data for risk stratification, either supplementary to imaging variables or without concurrent imaging. (abstract)
What's your diagnostic test workflow?
A recent paper in JACC: Cardiovascular Imaging reviewed literature on the latest advances in exercise stress electrocardiography (ExECG) and argued that despite the ACC's recommendations, the test is still "underutilized" as the initial diagnostic test modality for suspected coronary artery disease.
Continue reading Is ExECG your default diagnostic?