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

Better, Nathan; Webb, Myles B; Prior, David L; Unger, Steven A; Larcos, George

doi:10.5694/j.1326-5377.2011.tb03167.x

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To the Editor: Harper and Ko stress the importance of differentiating the presence of atherosclerosis from ischaemia,1 a concept that has been well understood for years. We agree that identifying myocardial ischaemia is important in the management of atherosclerosis; there are a variety of well validated non-invasive tools for this, including exercise electrocardiography, stress echocardiography, and nuclear myocardial perfusion imaging (MPI).

1 Royal Melbourne Hospital, Melbourne, VIC.
2 The Prince Charles Hospital, Brisbane, QLD.
3 St Vincent’s Hospital, Melbourne, VIC.
4 Queen Elizabeth Hospital, Adelaide, SA.
5 Westmead Hospital, Sydney, NSW.

Correspondence: Nathan.Better@mh.org.au

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. Hachamovitch R, Hayes S, Friedman JD, et al. Determinants of risk and its temporal variation in patients with normal stress myocardial perfusion scans: what is the warranty period of a normal scan? J Am Coll Cardiol 2003; 41: 1329-1340.
3. Freeman MR. Growing evidence that radionuclide imaging identifies management strategies that improve outcome. J Nucl Cardiol 2009; 16: 844-845.
4. Cerqueira MD, Allman KC, Ficaro EP, et al. Recommendations for reducing radiation exposure in myocardial perfusion imaging. J Nucl Cardiol 2010; 17: 709-718.
5. Brindis RG, Douglas PS, Hendel RC, et al. ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association. J Am Coll Cardiol 2005; 46: 1587-1605.

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