Article

A Selection of Recent Papers as Recommended by the Advisory Panel

Citation:US Cardiology 2007;4(1):11

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Relationship Between Noninvasive Coronary Angiography With Multi-slice Computed Tomography and Myocardial Perfusion Imaging
Schuijf JD, et al.
J Am Coll Cardiol, 2006;48(12):2508–14. Epub 2006 Nov 28.

The aim of this study was to perform a head-to-head comparison between multi-slice computed tomography (MSCT), which detects atherosclerosis, and myocardial perfusion imaging (MPI), which detects ischemia, in patients with an intermediate likelihood of coronary artery disease (CAD) and to compare non-invasive findings with invasive coronary angiography. A total of 114 patients, mainly with intermediate likelihood of CAD, underwent both MSCT and MPI. In a subset of 58 patients, invasive coronary angiography was performed. On the basis of the MSCT data, 41 patients were classified as having no CAD, of whom 90% had normal MPI. A total of 33 patients showed non-obstructive CAD, whereas at least one significant lesion was observed in the remaining 40 patients. Only 45% of patients with an abnormal MSCT had abnormal MPI; even in patients with obstructive CAD on MSCT, 50% still had a normal MPI. In the subset of patients undergoing invasive angiography, the agreement with MSCT was excellent (90%). The study concludes that MPI and MSCT provide different and complementary information on CAD, namely, detection of atherosclerosis versus detection of ischemia.

Financial Barriers to Healthcare and Outcomes After Acute Myocardial Infarction
Rahimi AR, et al.
JAMA, 2007;297(10):1063–72.

This study aimed to measure the baseline prevalence of self-reported financial barriers to healthcare services or medication (as defined by avoidance due to cost) among individuals following acute myocardial infarction (AMI) and their association with subsequent healthcare outcomes. The Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER), an observational, multicenter US study of patients with AMI in 2,498 individuals, was employed. Main outcome measures were health status symptoms (Seattle Angina Questionnaire, SAQ), overall health status function (Short Form-12), and rehospitalization. The prevalence of self-reported financial barriers to healthcare services or medication was 18.1% and 12.9%, respectively. Among individuals who reported financial barriers to healthcare services or medication, 68.9% and 68.5%, respectively, were insured. At one-year follow-up, individuals with financial barriers to healthcare services were more likely to have lower SAQ quality-of-life score and increased rates of all-cause and cardiac rehospitalization.

Evidence-based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update
Mosca L, et al.
J Am Coll Cardiol, 2007;49(11):1230–50.

This is not a study per se but rather an evaluation of the literature of published clinical trials related to heart disease prevention. Previous guidelines on prevention of heart disease in women were published by the American Heart Association in 1999 and 2004. These guidelines take into account new studies and the biggest changes in recommendations from previous guidelines, including the use of hormone therapy, aspirin therapy, antioxidants, and folic acid supplements. The guidelines classify women as being at high risk, at risk, or at optimal risk for developing heart disease, while the recommendations are grouped into lifestyle interventions and drug therapies to lower the levels of risk factors.

Measuring Performance for Treating Heart Attacks and Heart Failure: The Case for Outcomes Measurement
Harlan M, et al.
Health Affairs, 2007;26(1):75–85.

To complement the current process measures for treating patients with heart attacks and with heart failure, which target gaps in quality but do not capture patient outcomes, the Centers for Medicare and Medicaid Services (CMS) has proposed the public reporting of hospital-level 30-day mortality for these conditions in 2007. The case for including measurements of outcomes in the assessment of hospital performance, focusing on the care of patients with heart attacks and with heart failure, is presented. Recent developments in the methodology and standards for outcomes measurement have laid the groundwork for incorporating outcomes into performance monitoring efforts for these conditions.

Coronary Artery Calcium Scanning: Clinical Paradigms for Cardiac Risk Assessment and Treatment
Hecht HS, et al.
Am Heart J, 2006;151(6):1139–46.

Coronary artery calcium (CAC) scanning is being increasingly used for cardiac risk assessment in asymptomatic patients, particularly in those with a Framingham 10-year risk of 10–20%. With the goal of establishing clinical paradigms, this document integrates the results of key published articles, Framingham Risk Score, National Cholesterol Education Program Adult Treatment Plan III guidelines, American College of Cardiology/American Heart Association exercise testing and angiographic guidelines, and the authors’ extensive clinical experience. 

A Randomized Controlled Trial of Multislice Coronary Computed Tomography for Evaluation of Acute Chest Pain
Goldstein JA, et al.
J Am Coll Cardiol, 2007;49(8):863–71. Epub 2007 Feb 12.

Over 1 million patients have emergency center evaluations for acute chest pain annually, at an estimated diagnostic cost of over US$10 billion. MSCT has a high negative predictive value for exclusion of coronary artery stenoses. This study compares the safety, diagnostic efficacy, and efficiency of MSCT with standard diagnostic evaluation of low-risk acute chest pain patients. Patients were randomized to MSCT (n=99) versus SOC (n=98) protocols. Outcomes included safety (freedom from major adverse events over six months), diagnostic efficacy (clinically correct and definitive diagnosis), and time and cost of care. The study finds that MSCT coronary angiography can definitively establish or exclude coronary disease as the cause of chest pain. However, inability to determine the physiological significance of intermediate-severity coronary lesions and cases with inadequate image quality were found to present limitations.