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Coronary artery disease: to cath or not to cath? When and how best to cath: those are the remaining questions.

ABSTRACT: Coronary artery disease is the leading cause of death worldwide and it often clinically manifests as stable angina. The optimal diagnostic and therapeutic strategy of patients with stable angina may be controversial. Coronary revascularization with percutaneous coronary intervention (PCI) is associated with a reduction in cardiovascular events in patients with acute coronary syndrome, whereas recent trials have failed to demonstrate the superiority of myocardial revascularization over optimal medical therapy in stable angina. The treatment of a patient with stable angina is still challenging, as the definition of "stable" and "unstable" is not so clear. Moreover, the benefit of PCI in terms of quality of life is evident, and independent from its neutral effect on survival. To date, the best timing of coronary angiography and the role of further investigations on myocardial ischemia still need to be defined. On the other hand, in spite of the clear benefit on clinical outcome of an early invasive treatment of patients with acute coronary syndrome, elderly are often undertreated, whereas the overtreatment with PCI of stable patients undergoing non cardiac surgery might even increase ischemic events due to the premature discontinuation of the antiplatelet therapy, without reducing the perioperative risk.

SUBMITTER: Rossini R

PROVIDER: S-EPMC3584648 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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Coronary artery disease: to cath or not to cath? When and how best to cath: those are the remaining questions.

Rossini Roberta R Musumeci Giuseppe G Navarese Eliano Pio EP Tarantini Giuseppe G

American journal of cardiovascular disease 20130217 1

Coronary artery disease is the leading cause of death worldwide and it often clinically manifests as stable angina. The optimal diagnostic and therapeutic strategy of patients with stable angina may be controversial. Coronary revascularization with percutaneous coronary intervention (PCI) is associated with a reduction in cardiovascular events in patients with acute coronary syndrome, whereas recent trials have failed to demonstrate the superiority of myocardial revascularization over optimal me ...[more]

PMID: 23459399

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Project description:PurposeTo allow for comprehensive noninvasive diagnostics of coronary artery disease (CAD) by using three-dimensional (3D) image fusion of CT coronary angiography, CT-derived fractional flow reserve (CT FFR), whole-heart dynamic 3D cardiac MRI perfusion, and 3D cardiac MRI late gadolinium enhancement (LGE).Materials and methodsSeventeen patients (54 years ± 10 [standard deviation], one female) who underwent cardiac CT and cardiac MRI were included (combined subcohort of three prospective trials). Software facilitating multimodal 3D image fusion was developed. Postprocessing of CT data included segmentation of the coronary tree and heart contours, calculation of CT FFR values, and color coding of the coronary tree according to CT FFR. Postprocessing of cardiac MRI data included segmentation of the left ventricle (LV) in cardiac MRI perfusion and cardiac MRI LGE, co-registration of cardiac MRI to CT data, and projection of cardiac MRI perfusion and LGE values onto the high spatial resolution LV from CT.ResultsImage quality was rated as good to excellent (scores: 2.5-2.6; 3 = excellent). CT coronary angiography revealed significant stenoses in seven of 17 cases (41%). CT FFR was possible in 16 of 17 cases (94%) and showed pathologic flow in seven of 17 cases (41%), six of which coincided with cases revealing significant stenoses at CT coronary angiography. Cardiac MRI perfusion identified eight of 17 patients (47%) with hypoperfusion (ischemic burden of 17% ± 5). Cardiac MRI LGE showed myocardial scar in three of 17 cases (18%, scar burden of 7% ± 4). Conventional two-dimensional readout of CT coronary angiography and cardiac MRI resulted in eight of 17 cases (47%) with uncertain findings. Most of these divergent findings could be solved when adding information from CT FFR and 3D image fusion (six of eight, 75%).ConclusionMultimodal 3D cardiac image fusion is feasible and may help with comprehensive noninvasive CAD diagnostics.Supplemental material is available for this article.© RSNA, 2020.

Dataset Information

Coronary artery disease: to cath or not to cath? When and how best to cath: those are the remaining questions.

Publications

Coronary artery disease: to cath or not to cath? When and how best to cath: those are the remaining questions.

Similar Datasets

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