Sometimes, a non-invasive procedure will suffice

June 25, 2019

When a patient complains about chest pain, diagnosis will usually involve catheter angiography to evaluate the adequacy of blood supply to the heart. Researchers from Charité - Universitätsmedizin Berlin have now established that, in certain cases, the diagnostic reliability of non-invasive coronary computed tomography (CT) angiography is as good as that of coronary angiography - thereby dispensing with the need for invasive procedures. Results from this research have been published in The BMJ*.

Symptoms such as dull chest pain or a feeling of tightness in the chest may be indicative of coronary artery disease (CAD), a condition which develops when a narrowing of the coronary arteries limits the blood supply to the heart muscle. In the worst-case scenario, CAD can lead to a life-threatening heart attack or sudden cardiac death. Prompt diagnosis is therefore essential.

Until now, patients with suspected CAD have often been examined using cardiac catheterization for coronary angiography, a procedure that involves a tube (catheter) being inserted into a blood vessel via a small incision in the groin or arm and then advanced to the heart. The advantage of this method is that it combines diagnosis with treatment: if a narrowed segment is detected, the intervention to open up the affected artery can be performed immediately. However, the procedure is not without its risks, and out of a total of 880,000 patients who undergo the procedure in Germany every year, 58% do not require such an intervention. Led by Charité, an international research consortium has now been able to show that, in certain patients, an equally accurate diagnosis can be achieved using cardiac CT angiography - a non-invasive imaging method.

Research groups from 22 countries worked together to analyze the data of more than 5,300 patients from a total of 65 completed studies. Their analysis revealed that coronary CT angiography is a suitable diagnostic technique in patients with a low to intermediate probability of CAD. "Physicians can determine a patient's probability of having CAD using individual factors such as age, sex and type of chest pain," says study lead Prof. Dr. Marc Dewey, Deputy Head of the Department of Radiology on Campus Charité Mitte. "If this probability is between 7 and 67 percent, coronary CT angiography will provide a reliable diagnosis as to whether or not the patient has narrowed arteries. Cardiac catheterization is indicated in patients with higher probabilities, as these patients are likely to need an intervention."

"Cardiac CT is a gentle technique, which only lasts a few minutes," emphasizes the study's first author, Robert Haase, a doctoral student and member of Prof. Dewey's research group. The technique involves a circular X-ray machine taking 1,000 images per second from various angles. These images are then combined to produce a 3D reconstruction of the heart. Contrast agents are used to make the coronary arteries clearly visible. "Our work shows that, in both men and women, this method is capable of clearly visualizing narrowed segments," adds Robert Haase.

"Our findings will make it easier for physicians to determine which patients may benefit from having a coronary CT angiogram rather than a catheter-based procedure to diagnose coronary artery disease," says Prof. Dewey. The radiologist also hopes that the study will contribute to the harmonization of clinical practice guidelines. Country-specific guidelines continue to vary in terms of courses of action recommended when dealing with suspected CAD.
-end-
*Haase et al., Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data. BMJ. 2019; 365:l1945. doi: 10.1136/bmj.l1945

Charité - Universitätsmedizin Berlin

Related Coronary Artery Disease Articles from Brightsurf:

Researchers use multi-ancestry comparison to refine risk factors for coronary artery disease
An international group led by researchers from the RIKEN Center for Integrative Medical Sciences have used a combination of genome-wide association analysis--or GWAS--and a trans-ancestry comparison of different GWAS studies, to come up with a more accurate predictor of coronary artery disease based on genetic factors.

Oral radiography can reveal chronic coronary artery disease
A study found a link between carotid artery calcification observable in radiographs and coronary artery disease as well as several oral infections.

A new strategy to counter insulin damage in coronary artery disease
By studying blood vessel tissue from 674 patients, a research team has discovered how insulin contributes to the dysfunction of blood vessels in atherosclerosis, one of the most common chronic health conditions worldwide.

3D fusion imaging improves coronary artery disease diagnosis
A new technique that combines CT and MRI can bolster coronary artery disease diagnosis and help to define appropriate treatment for patients suffering from the disease, according to a new study.

Associations between vaspin levels and coronary artery disease
In a new publication from Cardiovascular Innovations and Applications; DOI https://doi.org/10.15212/CVIA.2019.0565, Lutfu Askin, Okan Tanriverdi, Hakan Tibilli and Serdar Turkmen from the Department of Cardiology, Adiyaman Education and Research Hospital, Adiyaman, Turkey consider associations between vaspin levels and coronary artery disease.

Waist size, not body mass index, may be more predictive of coronary artery disease
For years, women have been told that weight gain could lead to heart disease.

Women with coronary artery wall thickness at risk for heart disease
The thickness of the coronary artery wall as measured by MRI is an independent marker for heart disease in women, according to a new study.

SPIE journal reports advances in use of 3D models in assessing coronary artery disease
In an article published in SPIE's Journal of Medical Imaging (JMI), researchers announce critical advances in the use of 3D-printed coronary phantoms with diagnostic software, further developing a non-invasive diagnostic method for Coronary Artery Disease (CAD) risk assessment.

E-cigarettes linked to heart attacks, coronary artery disease and depression
Concerns about the addictive nature of e-cigarettes -- now used by an estimated 1 out of 20 Americans -- may only be part of the evolving public health story surrounding their use, according to data being presented at the American College of Cardiology's 68th Annual Scientific Session.

Is guideline-recommended therapy for coronary artery disease more likely in Medicare Advantage?
Medicare Advantage is Medicare's managed-care alternative to traditional fee-for-service Medicare.

Read More: Coronary Artery Disease News and Coronary Artery Disease Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.