CardioExchange Archive

Low Diagnostic Yield for Angiography: Coronary angiography as practiced in the U.S. has a startlingly low diagnostic yield, according to an important new study by Patel et al. in the New England Journal of Medicine using data from the ACC National Cardiovascular Data Registry. In 398,978 patients undergoing elective catheterization who did not have known coronary artery disease (CAD), only 149,739 (37.6%) were found to have obstructive disease. Nearly 40% had no evidence of CAD. The authors conclude that “current strategies that are used to inform decisions regarding invasive angiography, including clinical assessment of risk and noninvasive testing, need to be improved substantially to increase the diagnostic yield of cardiac catheterization in routine clinical practice.”
   
In an accompanying editorial, David Brenner notes that cardiac imaging is responsible for as much as 30% of radiation exposure from diagnostic imaging. “Ironically, there is evidence that, in many situations, a better gatekeeper test may be yet another radiographic imaging technique” —  CT angiography.

Is Acute MI Disappearing? From 2002 to 2007, the rate of hospitalization for acute MI among Medicare fee-for-service patients declined by 23.4%, according to a study by Chen et al. (led by CardioExchange editor-in-chief Harlan Krumholz) in Circulation. The rate of decline was slower among blacks, however. In an accompanying editorial, Russell Luepker and Alan Berger note that this observation is consistent with other data in different populations and ask: “Is acute myocardial infarction disappearing?”