Breakthrough in the management of patients complaining of suspicious chest pain: the selective use of heart CTintegrated in positive cases with a specific test on blood flow in the coronary arteries, it reduces the risk of death and heart attack by two thirds, avoiding unnecessary invasive tests. 'Jama Cardiology' put it in black and white, publishing the results of two analyzes of the international Precise clinical study which sees Italy as the protagonist with the Monzino Cardiology Center in Milan: the only center involved in our country, main enroller worldwide .
The analyzes of the data of 2,103 patients enrolled between December 2018 and May 2021 – explain the Lombard IRCCS – have shown that when a patient presents with chest pain, a suspected symptom for coronary artery problems, the precision diagnostic approach, which involves The use of coronary CT in specific cases and possibly the study of the Ffrct (Fractional flow reserve CT derived) parameter obtains much better results than the traditional approach which instead involves the use of a series of tests including coronary angiography, an invasive procedure. One year after enrollment, fewer deaths, fewer heart attacks and fewer coronary angiographies were observed in the group undergoing the precision procedure: on average, in patients with suspected coronary heart disease, the selective use of CT scanning can reduce the risk of death and heart attack by 65%avoiding unnecessary invasive tests.
“Precise is one of the most important studies for the management of chest pain and the risk of heart attack in the last decade – says Gianluca Pontone, director of the Department of Perioperative Cardiology and Cardiovascular Imaging at Monzino, principal investigator of the trial for the Milanese institute – Its extraordinary results had already been presented at the American Heart Association congress in April 2022 and now the publication in Jama Cardiology decrees the official entry of cardiac CT and Ffrct into clinical practice. Ffrct – recalls the specialist – is an analysis which Monzino began using and developing since 2013, which is carried out in the event of a positive CT scan to understand whether the narrowings found in the arteries actually have the capacity to cause ischemia, i.e. a significant obstruction to the flow of blood. Finally – announces Pontone – we have a clear and efficient path to solve the great problem of chest pain, which causes suffering and stress to patients and pressure on hospitals and emergency rooms”.
“It is estimated that in the USA alone, 4 million tests are carried out every year to investigate the origin of chest pain”, underlines the cardiologist. “The majority of these tests are useless – he specifies – and takes away resources and personnel from the healthcare systems. A problem that is particularly current in Italy these days”.
Today almost all patients who present with pain in the chest or arm are subjected to tests ranging, depending on the country and local traditions, from the stress test to the echocardiogram, up to coronary angiography – Monzino lists – almost independently of the their individual risk of coronary heart disease. “This – they point out from the Milanese Irccs – happens because the current clinical risk scores (age, gender, lifestyles and so on) are non-homogeneous and underperforming. No cardiologist therefore dares to wait to proceed with diagnostic tests in the face of ' pain': it is difficult to send a patient home without doing anything, in the uncertainty of what can happen”.
“The idea of the Precise study was born precisely from the need to overcome the management uncertainty of doctors faced with the sea of chest pain, or angina”, points out Pontone. “Thanks to precision technologies – he concludes – we have found the solution which requires all doctors to apply a single clinical score (Pmrs) and use it to decide what to do. If the Pmrs is low the patient does nothing, if it is high he is subjected to a cardiac CT scan and, if necessary, the CT data are also analyzed with FFRCT. This procedure is now validated and doctors can apply it without fear. Indeed, in the certainty of doing what is best for the patient.”
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