Decades of clinical research have consolidated the evidence that managing high risk acute coronary syndromes with an early invasive strategy — coronary angiography coupled with coronary revascularisation when appropriate — reduces cardiac mortality and the risk of recurrent myocardial infarction.1 Clinical trial evidence also supports coronary anatomic investigation of chest pain that suggests coronary artery disease (CAD), averting future myocardial infarction by facilitating initiation of preventive therapies.2 These insights provide the clinical rationale for coronary angiography.
- 1. Collet JP, Thiele H, Barbato E, et al; ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation. Eur Heart J 2021; 42: 1289‐1367.
- 2. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78: e187‐e285.
- 3. Chew DP, French J, Briffa TG, et al. Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study. Med J Aust 2013; 199: 185‐191. https://www.mja.com.au/journal/2013/199/3/acute‐coronary‐syndrome‐care‐across‐australia‐and‐new‐zealand‐snapshot‐acs‐study
- 4. Chew DP, MacIsaac AI, Lefkovits J, et al. Variation in coronary angiography rates in Australia: correlations with socio‐demographic, health service and disease burden indices. Med J Aust 2016; 205: 114‐120. https://www.mja.com.au/journal/2016/205/3/variation‐coronary‐angiography‐rates‐australia‐correlations‐socio‐demographic
- 5. Alexander M, Lan NSR, Dallo MJ, et al. Clinical outcomes and health care costs of transferring rural Western Australians for invasive coronary angiography, and a cost‐effective alternative care model: a retrospective cross‐sectional study. Med J Aust 2023; 219: 155‐161.
- 6. Khan E, Lambrakis K, Nazir SA, et al. Implementation of more sensitive cardiac troponin T assay in a state‐wide health service. Int J Cardiol 2022; 347: 66‐72.
- 7. Gray AJ, Roobottom C, Smith JE, et al; RAPID‐CTCA Investigators. Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial. BMJ 2021; 374: n2106.
- 8. Reynolds HR, Shaw LJ, Min JK, et al. Outcomes in the ISCHEMIA trial based on coronary artery disease and ischemia severity. Circulation 2021; 144: 1024‐1038.
- 9. Tideman PA, Tirimacco R, Senior DP, et al. Impact of a regionalised clinical cardiac support network on mortality among rural patients with myocardial infarction. Med J Aust 2014; 200: 157‐160. https://www.mja.com.au/journal/2014/200/3/impact‐regionalised‐clinical‐cardiac‐support‐network‐mortality‐among‐rural
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