Document Detail


A new algorithm for the management of stable coronary artery disease incorporating CT coronary angiography and fractional flow reserve: how we can improve outcomes and reduce costs.
MedLine Citation:
PMID:  21401459     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Computed tomography coronary angiography is the most reliable diagnostic test for coronary atherosclerosis. Stress testing should be reserved for diagnosis of myocardial ischaemia. Revascularisation, either by stenting or bypass grafts, is commonly performed in patients with stable coronary artery disease but is a double-edged sword. In the presence of ischaemia, revascularisation improves outcomes; in its absence, outcomes are worsened. In current practice, the decision of whether to revascularise is mainly made on the basis of the angiographic appearance of the coronary lesion in question. Physiological assessment of coronary lesions by the use of a pressure wire and measurement of fractional flow reserve (FFR) often shows that lesions thought to be sufficiently severe to warrant stenting or bypass do not cause ischaemia. A recent randomised study has shown that using FFR measurements to guide coronary stenting resulted in a lower use of stents, decreased costs and superior outcomes at 2 years, compared with traditional angiographic assessment alone. We believe that changes to the methods of health reimbursement are needed in both the public and private health systems, to facilitate greater use of FFR measurement.
Authors:
Richard W Harper; Brian S Ko
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  194     ISSN:  1326-5377     ISO Abbreviation:  Med. J. Aust.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-03-15     Completed Date:  2011-05-24     Revised Date:  2011-08-10    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  186-9     Citation Subset:  IM    
Affiliation:
MonashHeart, Southern Health, Monash Medical Centre, Melbourne, VIC, Australia. richard.harper@med.monash.edu.au
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Coronary Angiography / economics,  methods*
Coronary Artery Disease / diagnosis,  economics,  physiopathology,  radiography,  therapy*
Costs and Cost Analysis
Electrocardiography
Fractional Flow Reserve, Myocardial*
Humans
Myocardial Ischemia / diagnosis,  physiopathology
Myocardial Revascularization / methods
Tomography, X-Ray Computed
Treatment Outcome
Comments/Corrections
Comment In:
Med J Aust. 2011 Jun 20;194(12):666-7   [PMID:  21692734 ]
Med J Aust. 2011 Jun 20;194(12):667-8; author reply 669
Med J Aust. 2011 Jun 20;194(12):668; author reply 669
Med J Aust. 2011 Jun 20;194(12):668-9; author reply 669

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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