MR-Guided Care May Reduce Unnecessary Angiograms

September 12, 2016

Cardiovascular MR-guided care may reduce the number of unnecessary angiograms performed on patients with angina pectoris.

Cardiovascular magnetic resonance (CMR)-guided care reduces the probability of unnecessary angiography among patients with suspected coronary heart diseases (CHD), according to a study published in JAMA and presented at the European Society of Cardiology Congress 2016.

Researchers from the United Kingdom performed a randomized clinical trial to evaluate if CMR-guided care for patients with suspected CHD was superior to National Institute for Health and Care Excellence (NICE) guidelines–directed care and myocardial perfusion scintigraphy (MPS)–guided care in reducing unnecessary angiography.

A total of 1,202 symptomatic patients, aged 30 or older, from six hospitals with suspected angina pectoris and a CHD pretest likelihood of 10% to 90% participated in the trial. The patients’ mean age was 56.3 and 53%of all patients were male. The patients were randomly assigned to management according to UK NICE guidelines or to guided care based on the results of CMR or MPS testing; 240 patients were assigned to the UK NICE guidelines group, 481 patients to the group based on the results of CMR, and 481 patients based on MPS testing.

The researchers found that a CMR-guided strategy significantly reduced study-defined unnecessary angiography compared with NICE guidelines-guided care, but was not significantly different from an MPS-guided strategy:

	NICE guidelines: 240 patients	CMR Group: 481 patients	MPS Group: 481 patients
Patients who underwent invasive angiography after 12 months	102 patients (43%)	85 patients (18%)	78 patients (16%)
Unnecessary angiography	69 patients (28.8%)	36 patients (7.5%)	34 patients (7.1%)
Positive angiography proportions	29 patients (12.1%)	47 patients (9.8%)	42 patients (8.7%)
MACE reported at minimum of 12 months	1.7%	2.5%	2.5%

The researchers concluded that in patients with suspected angina, investigation by CMR resulted in a lower probability of unnecessary angiography within 12 months than NICE guideline–directed care, with no statistically significant difference between CMR and MPS strategies. There were no statistically significant differences in MACE rates.