Noninvasive imaging has high value in predicting major adverse cardiac event

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Researchers from John Hopkins have found that using a combination of noninvasive CT angiography and stress tests could help to predict which patients are at risk of suffering a heart attack or other major adverse cardiovascular event (MACE). 

Generally, invasive coronary angiography (ICA), which shows the blockages, and stress tests with single photon emission tomography (SPECT) myocardial imaging, which shows the perfusion or penetration of the blood into the tissue is used in making determinations. However, this approach that is generally safe can cause vascular problems in many patients and can also be expensive.

"The traditional approach with invasive catheterization requires that patients go to the hospital, get a catheter inserted into their leg and go in for the nuclear SPECT study on a different day," said study coauthor Marcus Chen, MD, from the National Institutes of Health in Bethesda, Maryland. "Now with just one noninvasive test we can get two important but different pieces of information about the coronary arteries."

The researchers published their findings in Radiology, as they set out to compare invasive and noninvasive approaches in 379 patients who were referred for ICA from November 2009 to July 2011. They assessed the ability of both techniques to predict whether or not a future major adverse cardiac event would occur.

Data showed that 31.5 percent of patients experienced one or more cardiac events, including 49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia.

Two years after presentation and event-free survival both techniques showed high values for predicting MACE.

"The key finding of our study is that both techniques are equally effective in identifying which patients are going to have trouble down the road," Lima said. "The noninvasive option should be a preferred or at least strongly considered option by cardiologists and radiologists managing these patients because it is safer and less expensive—and patients like it better."