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

Karamoskos, Peter

doi:10.5694/j.1326-5377.2011.tb03166.x

Topics

To the Editor: Although Harper and Ko’s effort at proposing an algorithm1 to reduce unnecessary cardiac catheterisation and stenting is laudable, it is concerning that they advocate investigating patients with stable coronary artery disease (CAD) using computed tomography coronary angiography (CTCA), with an algorithm, furthermore, that has not been validated in terms of patient outcomes.

Melbourne Specialist Imaging, Melbourne, VIC.

Correspondence: peter@pkara.org

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. Boden WE, O’Rourke RA, Teo KK, et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007; 356: 1503-1516.
3. Taylor F, Ward K, Moore THM, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2011; (1): CD004816. http://www2.cochrane.org/reviews/en/ab00481 6.html (accessed Mar 2011).
4. Phurrough SE, Salive ME, Baldwin J, Chin J. Decision memo for computed tomographic angiography (CAG-00385N). Baltimore: Centers for Medicare & Medicaid Services, 2008. http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=206&ver=17&NcaName=Computed+Tomographic+Angiography&DocID=CAG-00385N (accessed Mar 2011).
5. Redberg RF, Walsh J. Pay now, benefits may follow — the case of cardiac computed tomographic angiography. N Engl J Med 2008; 359: 2309-2311.

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