Quick Fire Session
SCMR 22nd Annual Scientific Sessions
Current guidelines for the appropriateness of coronary x-ray angiography (CXA) include typical angina and previous positive stress test in intermediate risk patients.
Methods: On a 1:1 randomization patients presenting with typical angina, positive prior stress test other than CMR, and intermediate CAD probability were included either into a CXA or CMR guided therapy group. All patients received optimal medical therapy according to current guidelines. All CMR subjects underwent adenosine (140µg/kg/min for 3 minutes) CMR at 3 Tesla (0.075 mmol Gd-DOTA/kg). Patients in the CMR group only underwent CXA, if myocardial ischemia was detected. All patients in the CXA arm underwent CXA procedure. PCI was performed in case of significant stenosis (>75% in LAD, CX, or RCA or >50% in LM). Clinical and medical cost follow-up was performed for three years in all patients. A composite primary endpoint was defined as cardiovascular death or non-fatal myocardial infarction.
Mean per patient baseline costs for the first three months after inclusion into the study were 1,463.77 ± 174.34 €, cumulative costs after three years were 2,480.42 ± 407.36 €. Baseline costs (per patient) in the CMR group were significantly lower compared to the CXA group (1,105.71 ± 258.56 € vs. 1,864.23 ± 212.41 €, pCXA and CMR group did not differ significantly in the primary endpoint (p=0.16).
Conclusion: CMR guided CAD therapy is cost effective and does not result in higher cardiovascular events compared to conventional guided therapy. Hence, CMR can be used for a cost-effective management in patients with stable CAD.