[Invasive treatment of angina pectoris. A need for re-thinking?].
Evaluation and treatment of stable angina pectoris is based on invasive diagnostic and therapeutic procedures focused on identification and treatment of coronary artery stenoses, instead of myocardial ischaemia which is considered the cause of symptoms. Thus, coronary angiography should possibly be preceded routinely by myocardial perfusion imaging, which can provide the diagnosis of ischaemia and determine if the patient will benefit from invasive therapy. As a consequence, treatment of patients without ischaemia and patients with ischaemia so serious that invasive therapy is futile might be avoided. It is unknown exactly how many angiographies and treatments with angioplasty or bypass surgery that could be spared in this way. It is estimated that a patient pathway based on the diagnosis of myocardial ischaemia including the type of ischaemia may render approximately half of the present angiographies and a number of invasive revascularisations redundant. This pathway implies substantial economic savings.
Odense Universitetshospital, nuklearmedicinsk afdeling.
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PF
Høilund-Carlsen
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O
Amtorp
D000787:Angina Pectoris / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000191:economics / Q000706:statistics & numerical data; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005080:Exercise Test; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis; D009204:Myocardial Revascularization / Q000191:economics / Q000379:methods