Non-invasive testing in chronic coronary syndrome: Comparison between functional and anatomic approach

Q: What are the key findings of this study?

Coronary CT angiography and functional testing showed no significant difference in the primary composite outcome (3.3% vs 3.0%) during a median follow-up of 25 months.

Q: What is the clinical evidence from this study?

Study design: Review. Population: Chronic coronary syndrome. Intervention: Coronary CT angiography (CTA) vs. Functional testing (perfusion scintigraphy, stress echocardiography, stress electrocardiography). Primary outcome: All-cause mortality, myocardial infarction, unstable angina requiring hospitalization and complications of cardiovascular procedures.

Q: What does this research mean for the field?

Coronary CTA and functional testing are complementary methods for diagnosing chronic coronary syndrome, each suited to different clinical probabilities of disease. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Vojislav Giga; Nikola Bošković; Ana Đorđević-Dikić; Ivana Nedeljković; Branko Beleslin

doi:10.5937/siks2104261g

January 1, 2021Srce i krvni sudoviOpen Access

Non-invasive testing in chronic coronary syndrome: Comparison between functional and anatomic approach

View Full Paper

Ask AI

Bookmark

Share

Key result

Coronary CTA and functional testing complement each other in diagnosing CCS across different disease probabilities.

3.3% vs 3.0%

Why the study?

With coronary CT angiography emerging as an alternative to functional testing in chronic coronary syndromes, the review aims to detail the advantages, limitations, and complementary nature of both techniques.

Does coronary CT angiography compared to functional testing improve diagnosis and risk stratification in patients with chronic coronary syndrome?

Key Points

To review the advantages, limitations, and complementary roles of functional testing and coronary CT angiography in diagnosing and risk-stratifying patients with chronic coronary syndrome.
Narrative synthesis of clinical trial evidence comparing functional testing (perfusion scintigraphy, stress echocardiography, exercise ECG) with anatomic testing (coronary CT angiography).
Analysis centered on diagnostic accuracy, prognostic thresholds, and clinical outcomes reported in contemporary randomized trials, including PROMISE and SCOT-HEART.
In the PROMISE trial, 25-month primary outcome rates showed no significant difference between functional testing (3.0%) and coronary CT angiography (3.3%).
Negative coronary CT angiography conferred an adverse event rate of 0.93% (negative predictive value ~99%), whereas event rates after negative functional tests were 2.09% overall and 0.92% among patients with Framingham risk scores < 10%.

Structured PICO

Does coronary CT angiography compared to functional testing improve diagnosis and risk stratification in patients with chronic coronary syndrome?

P

Population

A review of patients with chronic coronary syndrome and chest pain comparing functional and anatomical non-invasive testing.

I

Intervention

Coronary CT angiography (CTA)

C

Comparator

Functional testing (e.g., perfusion scintigraphy, stress echocardiography, stress electrocardiography)

O

Outcome

Diagnosis and risk stratification of obstructive coronary artery disease and prediction of future adverse events

Main Result

Absolute Event Rate: 3.3% vs 3%

CTA and functional testing are complementary in evaluating chronic coronary syndrome, with CTA preferred for lower pre-test probability to exclude disease and detect vulnerable plaques, and functional testing for higher probability to confirm ischemia.

Limitations

Functional tests have limited ability to predict the occurrence of acute thrombotic coronary artery occlusion in the presence of mild coronary atherosclerosis.
False negative readings in functional tests can occur due to low workload, single vessel disease, or balanced ischemia in multi-vessel disease.

Implication

May guide test selection by pretest probability in chronic coronary syndrome; leaves open need for prospective outcome trials.

Abstract

For the decades, functional testing has been a cornerstone of non-invasive diagnosis and risk stratification in patients with chronic coronary syndromed. With technological improvements coronary CT angiography (CTA) became alterntative method for the assessment of coronary circulation. The aim of this review paper is to show the advantages and limitations of both tecniques and to demonstrate their complementary nature.CTA and functional tests represent complementary methods for the evaluation of patients with chest pain, whereas each method has its place in the diagnostic algorithm. Functional tests are indicated in patients with high clinical probability for the presence of obstructive coronary artery disease for the confirmation of the disease and risk stratification. CTA is indicated in patients with lower clinical probability for the presence of obstructive coronary artery disease when the exclusion of the disease is the major intention. Also, it can be used in patients with chest pain and previous negative functional test in order to establish the presence of non-obstructive vulnerable plaques in order to initiate cardioprotective therapy and prevent future events.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Giga et al. (2021) conducted a review in Chronic coronary syndrome. Coronary CT angiography (CTA) vs. Functional testing (perfusion scintigraphy, stress echocardiography, stress electrocardiography) was evaluated on All-cause mortality, myocardial infarction, unstable angina requiring hospitalization and complications of cardiovascular procedures. Coronary CT angiography and functional testing showed no significant difference in the primary composite outcome (3.3% vs 3.0%) during a median follow-up of 25 months.

synapsesocial.com/papers/69785538ccb046adae517774 https://doi.org/10.5937/siks2104261g

View Full Paper

Ask AI

Bookmark

Share

Non-invasive testing in chronic coronary syndrome: Comparison between functional and anatomic approach

Key Points

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Non-invasive testing in chronic coronary syndrome: Comparison between functional and anatomic approach

Key Points

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading