Cost-effectiveness for imaging stable ischemic disease

• Type of Material: Article
• Authors: Silanath Terpenning, Emory University; Arthur Stillman, Emory University
• Language: English
• Date: 2020-01-01
• Publisher: BRITISH INST RADIOLOGY
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Authors. Published by the British Institute of Radiology
• Final Published Version (URL): http://dx.doi.org/10.1259/bjr.20190764
• Title of Journal or Parent Work: BRITISH JOURNAL OF RADIOLOGY
• Volume: 93
• Issue: 1113
• Start Page: 20190764
• End Page: 20190764
• Keywords: TESTS; Life Sciences & Biomedicine; HEALTH; CHEST-PAIN; STRATEGIES; Radiology, Nuclear Medicine & Medical Imaging; ANGIOGRAPHY; HEART; CORONARY-ARTERY-DISEASE; Science & Technology; FRACTIONAL FLOW RESERVE
• Research Categories: Health Sciences, Radiology

Abstract

Stable ischemic heart disease remains a major cause of morbidity and mortality. Although there are multiple imaging modalities to diagnose and/or assist in the clinical management, the most cost-effective approach remains unclear. We reviewed the relevant and recent evidence-based clinical studies and trials to suggest the most cost-effective approach to stable ischemic heart disease. The limitations of these studies are discussed. Incorporating the results of recent multicenter trials, we suggest that for appropriate patients with coronary artery disease with any degree of stenosis or presence of coronary calcium, optimal medical therapy may be most cost-effective. Invasive coronary angiography and/or coronary revascularization would be primarily for non-responders or >/=50% left main stenosis. Stress cardiac magnetic imaging would be performed for those patients with non-diagnostic coronary CT angiography from motion and non-responders from optimal medical therapy in non-diagnostic coronary CT angiography group from high coronary calcium. These paths seem to be safe and cost-effective but requires modeling for confirmation.