Non-invasive ischemia evidence in stable invasive clarified coronary patients

Abstract

Background: Ischemic heart disease causes the highest number of deaths in industrialized countries. Patients who present with symptoms suspicious of stable coronary artery disease undergo non-invasive testing before an invasive coronary angiography (CA). The aim of this study was to evaluate which non-invasive test is the best method, in order to diagnose obstructive coronary artery disease (CAD) reliably in stable coronary patients. Methods: This data analysis is a retrospective study with 587 included patients. All patients, who underwent both an elective CA in 2015 (01.01.2015-31.12.2015) at the cath lab at the University Clinic in Graz and have got at least one non-invasive cardiac investigation before invasive CA, were included in this trial. The non-invasive tests implicated ergometry, myocardial perfusion imaging (MPI), coronary computed tomography angiography (CCTA) and magnet resonance imaging (MRI). Results: 569 participants were tested positive in their previous non-invasive procedure and 265 of these (47%) were diagnosed with obstructive CAD in CA. MRI demonstrated the highest accuracy (63%) in the study population with 10 patients out of 16 who presented with obstructive CAD in CA and a previous positive MRI. Ergometry reached the second highest accuracy (53%) followed by CCTA (47%) and MPI (45%). Diagnostic CA required an intervention in 277 patients of the study population (n=587) and of these 208 patients underwent percutaneous coronary intervention. Conclusion: In conclusion, this study suggests that MRI could be an attractive alternative in non-invasive testing and that MRI is an effective gatekeeper for invasive CA. Furthermore, this study evaluates that ergometry has a higher accuracy compared to CCTA and MPI.

Date of Award	2018
Original language	English
Awarding Institution	Medical University Graz
Supervisor	Gabor Toth-Gayor (Supervisor) & Robert Zweiker (Co-supervisor)