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Investigating chest pain: anatomy or function?

22 May, 15 | by Alistair Lindsay

Among patients with chest pain, it is unclear if anatomic assessment of coronary obstruction or functional assessment with stress testing leads to better patient outcomes. In this randomized controlled trial of 10,003 symptomatic patients, individuals were randomly assigned in a 1:1 fashion to either anatomical testing with coronary CT angiography (CTA) or to functional testing by one of several different modalities (exercise ECG (10%), nuclear stress testing (67%) or stress echo (23%)).  Instead of diagnostic accuracy, as is seen with most such studies, the trial was powered for clinical outcomes with a primary composite endpoint of death, myocardial infarction, hospitalization for unstable angina, or major procedural complication.  more…

Coronary Artery Disease Screening Using CT Angiography Lacks Benefit

1 Feb, 15 | by Alistair Lindsay

Although prior studies of screening for coronary artery disease (CAD) in high-risk patients have failed to demonstrate benefit, screening with cardiac coronary computed tomography (CCTA) may hold promise by providing more detail on the extent of coronary atherosclerosis.  This trial randomized 900 patients with a 3 to 5 years history of type 1 or 2 diabetes mellitus, but without known CAD, to screening with cardiac CCTA versus usual care.  Patients randomized to CCTA received management recommendations based on scan results that included aggressive risk factor modification for findings of CAD.  The primary outcome was a composite of all-cause mortality, nonfatal myocardial infarction, or unstable angina requiring hospitalization.   more…

CARDIA – Abdominal obesity and coronary artery calcium

14 Aug, 13 | by Alistair Lindsay

Over the past three decades, obesity rates for adults have doubled and rates for adolescents have tripled. Therefore, younger people are experiencing a greater cumulative exposure to excess adiposity over their lifetime, however the long-term effects of this have been poorly studied to date. In particular, abdominal obesity is known to cause the development of atherosclerosis independent of overall adiposity, however no study has to date examined whether the duration of abdominal obesity contributes to the development or progression of atherosclerosis. more…

Novel risk markers – CT looks strong

2 Oct, 12 | by Alistair Lindsay

The primary prevention of cardiovascular disease involves classifying individuals according to their global cardiovascular risk. However, those at intermediate risk represent a particular challenge; while some may require aggressive treatment, others may be best managed by lifestyle measures alone. Biomarkers that have shown promise in improving risk discrimination include carotid intima-media thickness (CIMT), coronary artery calcium (CAC) scoring, brachial flow-mediated dilation (FMD), ankle-brachial index (ABI), high-sensitivity C-reactive protein (CRP) and, in addition, having a family history of coronary heart disease (CHD). Determining whether – and by how much – risk prediction can be improved by various markers could help to determine the most efficient strategy for the use of primary prevention drugs. more…

64-slice CT unable to out-perform coronary angiography

17 Jan, 09 | by Alistair Lindsay

Previous studies comparing CT coronary angiography with the current gold standard of coronary angiography have been limited by single-centre design and inherent bias in small studies.  This multi-centre, international study, CORE 64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) used central blinded analysis to evaluate the diagnostic accuracy of MDCT angiography involving 64 slice detectors and a slice thickness of 0.5mm in order to identify symptomatic patients with suspected CAD who should be referred for conventional coronary angiography. Patients with Agatston calcium scores>600 were pre-specified to be excluded from the analysis and entered into a registry. Patients were followed up for the interim occurrence of death, MI, stroke, revascularisation (percutaneous or surgical), hospitalisation for angina or heart failure and other serious adverse events at 7 and 30 days. more…

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