A new algorithm for the management of stable coronary artery disease incorporating CT coronary angiography and fractional flow reserve: how we can improve outcomes and reduce costs

Kalff, Victor; Duffy, Stephen J; Taylor, Andrew J

doi:10.5694/j.1326-5377.2011.tb03164.x

Topics

To the Editor: Harper and Ko recently suggested radically changing the way we investigate patients with stable coronary artery disease (CAD), stating that they should initially undergo computed tomography coronary angiography (CTCA), with subsequent stress testing if CTCA shows atherosclerosis.1 To save costs, they recommend excluding stress nuclear myocardial perfusion imaging (MPI) because it has similar accuracy to stress echocardiography and involves ionising radiation.

Alfred Hospital, Melbourne, VIC.

Correspondence: Victor.Kalff@monash.edu

1. Harper RW, Ko BS. A new algorithm for the management of stable coronary artery disease incorporating CT coronary angiography and fractional flow reserve: how we can improve outcomes and reduce costs. Med J Aust 2011; 194: 186-189. <MJA full text>
2. Gaemperli O, Schepis T, Valenta I, et al. Cardiac image fusion from stand-alone SPECT and CT: clinical experience. J Nucl Med 2007; 48: 696-703.
3. Beller GA, Ragosta M. Decision making in multivessel coronary disease: the need for physiological lesion assessment. JACC Cardiovasc Interv 2010; 3: 315-317.
4. Hachamovitch R, Rozanski A, Shaw LJ, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J 2011; Jan 21. [Epub ahead of print.]

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