Nav: Home

CE-MARC 2: Pointing the way to fewer invasive angiograms

August 29, 2016

Rome, Italy - 29 August, 2016: Initial investigation of patients with suspected coronary heart disease (CHD) using functional imaging - rather than guideline-directed care - resulted in significantly less unnecessary angiography, according to results of the CE-MARC 2 trial.

The findings, presented in a Hot Line session at ESC Congress 2016, and published simultaneously in JAMA, could have an important impact on referral rates for invasive coronary angiography, and potentially healthcare costs, said lead investigator John Greenwood, PhD, from the University of Leeds, in Leeds, United Kingdom.

"Rates of invasive angiography are considered too high among patients with suspected coronary heart disease," explained Professor Greenwood.

"Our findings show that both cardiovascular magnetic resonance (CMR) and myocardial perfusion scintigraphy (MPS) significantly reduced rates of unnecessary angiography compared to guideline-directed care, with no penalty in terms of major adverse cardiovascular events (MACE). This suggests that functional imaging should be adopted on a wider basis, even in high-risk patient subgroups."

The Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC 2) trial included 1,202 patients with suspected CHD from six UK centers.

The patients were randomised to functional imaging-based investigation with either CMR (n = 481) or MPS (n = 481), or to guideline-directed investigation (n=240) based on National Institute for Health and Care Excellence (NICE) guidelines.

In this latter group, those with a pre-test likelihood of 10%-29% (meaning low risk for CHD based on age, gender, symptom characteristics, and clinical history) were scheduled for cardiac computed tomography (CCT), those with a pre-test likelihood of 30% to 60% (intermediate risk) were scheduled MPS, and those with a high pre-test likelihood were sent directly to coronary angiography.

The primary end point was unnecessary coronary angiography within 12 months, (defined by absence of significant stenosis measured by fractional flow reserve or quantitative coronary angiography), with secondary end points of MACE, and positive angiography within this same time period.

Overall, 22% of the study population underwent coronary angiography within 12 months, with unnecessary angiograms occurring in 28.8% of the NICE guidelines group, 7.5% of the CMR group, and 7.1% of the MPS group, reported Professor Greenwood.

The adjusted odds ratio of unnecessary angiography for the CMR group versus the NICE guidelines group was 0.21 (95% CI, 0.12-0.34; P < .001), with no statistically significant difference between the CMR and MPS groups.

Between the three strategies, there was no difference in short-term MACE or positive angiography rates.

"Worldwide, MPS is the most commonly used test to assess suspected CHD, but CMR is increasingly recognized as having high diagnostic accuracy and prognostic value," noted Professor Greenwood. "Although the results of CE-MARC 2 showed no difference between the CMR and MPS strategies in terms of unnecessary angiography rates, our original CE-MARC study showed that CMR had a higher diagnostic accuracy compared to MPS (Lancet 2012; 379(9814):453-460) and was also a stronger predictor of risk for MACE (Annals of Internal Medicine 2016; 165(1):1-9)."

He concluded that "these results show that a broader use of functional imaging (CMR or MPS), in low, intermediate and high risk patient groups, could reduce the rates of invasive angiography that ultimately show no obstructive coronary disease. In addition, CE-MARC and CE-MARC 2 further support the role of CMR as an alternative to MPS for the diagnosis and management of patients with suspected CHD."
-end-
Notes to editors

Sources of funding: The trial was funded by grants and fellowships from the British Heart Foundation; the Leeds Teaching Hospital Charitable Foundation; the National Institute for Health Research; and the Scottish Funding Council.

Disclosures: Professor Greenwood reported no relevant disclosures.

ESC Press Office

For background information, please contact the ESC Press Office at media@escardio.org.

For press enquiries, please contact, the Media & Press Coordinator, Jacques Olivier Costa: +393427028575

For independent comment on site, please contact the ESC Spokesperson coordinator, Celine Colas: +393402405148

To access all the scientific resources from the sessions during the congress, visit ESC Congress 365.

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 120 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2016

ESC Congress is the world's largest gathering of cardiovascular professionals contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2016 takes place 27 to 31 August at the Fiera di Roma in Rome, Italy. The scientific programme is here. More information is available from the ESC Press Office at press@escardio.org

This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2016. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.

European Society of Cardiology

Related Coronary Heart Disease Articles:

New study highlights smoking intensity in coronary heart disease risk
Increased relative risks for coronary heart disease (CHD) have long been associated with smoking, and traditionally they have been dependent on the number of cigarettes smoked a day, smoking intensities, and total exposure over time.
Pessimism associated with risk of death from coronary heart disease
Pessimism seems to be a strong risk factor for death from coronary heart disease, while optimism does not protect from it, according to a study published in the open-access journal BMC Public Health that involved 2,267 middle-aged and older Finnish men and women.
Study finds large decrease in coronary heart disease in US
The incidence of coronary heart disease in the US declined nearly 20 percent from 1983 to 2011, according to a study appearing in the Nov.
Study of Israelis & Palestinians rethinks how HDL protects against coronary heart disease
Studying a population of Israelis and Palestinians, researchers from the Hebrew University of Jerusalem found that medium-sized HDL particles (MS-HDL-P) and the number of HDL particles (HDL-P) are better markers of coronary artery disease than high-density lipoprotein cholesterol (HDL-C).
Americans are getting heart-healthier: Coronary heart disease decreasing in the US
Coronary heart disease is one of the leading causes of death in the United States.
Little cost difference between tests to diagnose coronary heart disease
For patients with suspected coronary artery disease, computed tomographic angiography and functional diagnostic testing strategies have similar costs through three years of follow up.
Study shows minorities had lower risk of coronary heart disease than whites
In a study of more than 1.3 million Kaiser Permanente members in Northern California that stretched over 10 years, researchers found that blacks, Latinos and Asians generally had lower risk of coronary heart disease compared to whites.
The evidence for saturated fat and sugar related to coronary heart disease
Atherosclerotic Coronary Heart Disease (CHD) is responsible for one in every six deaths in the United States as well as being the leading cause of death throughout the developed world.
Coronary heart disease patients with no teeth have nearly double risk of death
Coronary heart disease patients with no teeth have nearly double the risk of death as those with all of their teeth, according to research published today in the European Journal of Preventive Cardiology.
Shorter height is directly associated with increased risk of coronary heart disease
A University of Leicester-led study uses genetic approach to show link between height and disease.

Related Coronary Heart Disease Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Climate Crisis
There's no greater threat to humanity than climate change. What can we do to stop the worst consequences? This hour, TED speakers explore how we can save our planet and whether we can do it in time. Guests include climate activist Greta Thunberg, chemical engineer Jennifer Wilcox, research scientist Sean Davis, food innovator Bruce Friedrich, and psychologist Per Espen Stoknes.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...