A survey comparing 2 approaches for diagnosing bosom illness recovered that a hazard investigation strategy is superior to the accustomed attack of instantly performing functional tests oregon catheterization for low- to intermediate-risk patients with new-onset thorax pain.
Presented Nov. 6 astatine the American Heart Association's 2022 Scientific Sessions, the survey bolsters a risk-analysis strategy that either defers investigating among low-risk patients, oregon uses coronary computed tomography angiography (CTA), a CT scan with a opposition cause to measure for blockages.
The hazard investigation attack has been outlined successful guidelines and is championed arsenic a means of reducing often unnecessary and costly tests. It has ne'er been tested rigorously successful a randomized trial, however, and its objective exertion has lagged without definitive grounds of its effectiveness compared to assorted functional accent tests.
"New onset thorax symptom is simply a communal objective occupation that involves a batch of testing, enactment and expense," said survey pb Pamela S. Douglas, M.D., a subordinate of the Duke Clinical Research Institute and the Ursula Geller Professor of Research successful Cardiovascular Diseases astatine Duke University School of Medicine.
"Our survey provides grounds that, among low-risk patients, the tests volition apt beryllium antagonistic for coronary artery illness and patients volition spell connected to bash well," Douglas said. "As a result, we should beryllium deferring investigating successful these low-risk people."
Douglas and colleagues enrolled much than 2,100 patients crossed the U.S. and Europe with new-onset thorax symptom successful the PRECISE objective trial. Participants' mean property was 58, with astir adjacent numbers of men and women.
Half of the patients were randomly assigned to person accustomed investigating -- including accent echocardiogram, atomic accent test, accent MRI oregon catheterization -- which physicians selected astatine their discretion.
The different fractional of participants were randomized to the precision strategy, which uses a
pre-test probability appraisal to usher adjacent steps, including deferred investigating oregon CTA, with selective usage of representation investigation bundle to find the value of immoderate blockages.
Within some groups, astir 21% of symptomatic patients were assessed to beryllium astatine debased hazard of bosom disease. Of these low-risk patients successful the accustomed investigating group, 86% underwent immoderate benignant of test, compared to 37% successful the precision strategy group.
The superior absorption was whether, wrong a year, determination were immoderate differences betwixt the 2 diagnostic approaches for immoderate operation of the pursuing outcomes: deaths from immoderate cause, nonfatal myocardial infarction, oregon catheterizations that did not amusement blockages and whitethorn person been unnecessary.
The researchers recovered that the precision strategy substantially reduced the incidence of the composite endpoint compared to the accustomed accent investigating approaches.
To supply a afloat representation of objective value, the investigators balanced this demonstrated effectiveness with introspection of immoderate information concerns. There were nary differences successful decease oregon the composite of decease and myocardial infarction, but determination was a small, non-significant quality successful nonfatal myocardial infarction successful the precision group.
In stable, symptomatic patients with suspected bosom illness who physicians consciousness necessitate testing, a precision strategy incorporating a acceptable of actions based connected line recommendations, volition amended outcomes compared to accustomed testing."
Pamela S. Douglas, M.D., Member of the Duke Clinical Research Institute and the Ursula Geller Professor of Research successful Cardiovascular Diseases, Duke University School of Medicine
In summation to Douglas, survey authors see Michael G. Nanna, Michelle D. Kelsey, Eric Yow, Daniel B. Mark, Manesh R. Patel, Campbell Rogers, James E. Udelson, Christopher B. Fordyce, Nick Curzen, Gianluca Pontone, Pál Maurovich-Horvat, Bernard De Bruyne, John P. Greenwood, Victor Marinescu, Jonathon Leipsic, Gregg W. Stone, Ori Ben-Yehuda, Colin Berry, Shea E. Hogan, Bjorn Redfors, Ziad A. Ali, Robert A. Byrne, Christopher M. Kramer, Robert W. Yeh, Beth Martinez, Sarah Mullen, Whitney Huey, Kevin J. Anstrom, Hussein R. Al-Khalidi, and Sreekanth Vemulapalli, for the PRECISE Investigators/
The survey received backing from HeartFlow, a aesculapian exertion company.
English (US)