[Invasive treatment of angina pectoris. A need for re-thinking?]

Area of Science:

• Cardiology
• Diagnostic Imaging
• Interventional Cardiology

Context:

• Current stable angina pectoris management relies on invasive procedures targeting coronary stenoses, not the underlying cause, myocardial ischemia.
• Coronary angiography is frequently used, but its routine use may not always be indicated.
• The causal link between coronary artery stenosis and symptoms is not always direct, necessitating a focus on ischemia.

Purpose:

• To propose a diagnostic pathway for stable angina that prioritizes myocardial ischemia detection.
• To evaluate the potential of myocardial perfusion imaging to guide invasive therapy decisions.
• To determine if non-invasive ischemia assessment can reduce unnecessary angiographies and revascularizations.

Summary:

• A patient pathway incorporating myocardial ischemia diagnosis, including its type, could potentially eliminate nearly half of current coronary angiographies.
• Myocardial perfusion imaging can diagnose ischemia and predict benefit from invasive therapy, guiding treatment decisions.
• This diagnostic strategy may prevent futile invasive treatments for patients without ischemia or with severe ischemia unresponsive to intervention.

Impact:

• Implementing ischemia-focused diagnostics may significantly reduce the number of invasive procedures like angioplasty and bypass surgery.
• This approach promises substantial economic savings within healthcare systems by avoiding non-indicated invasive treatments.
• Improved patient selection for invasive procedures can lead to more effective and cost-efficient management of stable angina.