Key result
Functional testing with SPECT or stress echocardiography as a gateway to angiography resulted in equivalent exercise times at 18 months compared to direct angiography, avoiding invasive testing in 20-25% of patients.
Why the study?
Does functional cardiac testing (SPECT, MRI, or stress echocardiography) maintain exercise time and improve cost-effectiveness compared to direct angiography in patients with suspected or known CAD?
Population
898 patients with suspected or known coronary artery disease and an exercise test result that required…
Comparison
Functional cardiac testing as an initial… vs Direct non-urgent coronary angiography.
Design
RCT, Randomised to one of the four initial diagnostic tests.
Follow-up
18 months
Authors
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Supports functional testing as initial strategy in suspected CAD; extends RCT evidence for reducing unnecessary angiography without loss of functional capacity.
RCT (n=898)
randomised
No
Does functional cardiac testing (SPECT, MRI, or stress echocardiography) maintain exercise time and improve cost-effectiveness compared to direct angiography in patients with suspected or known CAD?
Using functional testing (particularly SPECT) as a gateway to angiography in patients with suspected CAD allows 20-25% to avoid invasive testing without compromising functional outcomes, at a modest additional cost.
Sharples et al. (2007) conducted an RCT in Coronary artery disease (n=898). Functional cardiac testing (SPECT, MRI, or stress echocardiography) vs. Coronary angiography was evaluated on Total exercise time at 18 months (modified Bruce protocol). Functional testing with SPECT or stress echocardiography as a gateway to angiography resulted in equivalent exercise times at 18 months compared to direct angiography, avoiding invasive testing in 20-25% of patients.
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