Thus tailor-made tests reveal the risk of heart attack in those with chest pain
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Pain behind the breastbone, moving upwards and perhaps moving towards the neck, shoulders and arms. When you think of heart attack and angina pectoris, this is the most classic symptom that comes to mind. It is essential, in these circumstances, to call for help immediately because time is essential to protect the heart. But the symptom of chest pain, regardless of these conditions of urgency, in all cases must still be studied with care. Also to understand if and how much depends on any obstruction of circulation within the coronary arteries, which carry blood and oxygen to the heart.
Now international research shows that thanks to targeted imaging techniques it is possible to reduce by as much as 65% the risk of death from a heart attack and unnecessary invasive tests in subjects with suspected coronary heart disease. To say it are the results of the international study Accuratein which the Monzino Cardiological Center participated for Italy, presented recently at the congress of theAmerican Heart Association.
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What are the two key exams
There are two fundamental exams in this course of study: the Cardiac CT and especially the FFRCT test (Fractional Flow Reserve CT-derived), a parameter that allows us to understand whether the narrowing found in the arteries actually has the ability to cause a significant obstruction to the blood flow.
“The results of the Precise study are of great relevance to clinical practice because they offer for the first time an optimal and non-invasive solution to the complex problem of diagnosing chest pain in patients without previous heart problems,” he explains. Gianluca Pontone, Director of the Monzino Department of Perioperative Cardiology and Cardiovascular Imaging. Throughout the Western world, this widespread disorder leads to an enormous volume of tests every year (4 million in the USA alone) with very high costs for patients, in terms of stress and invasiveness, and for health systems. The core of the problem is that until recently there was not enough evidence for paths that would help the doctor choose whether to undergo an examination or not and above all, in the face of a low-risk patient, to agree to do nothing and wait” .
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What the study says
The Precise study enrolled in Europe and the USA, in the period December 2018-May 2021, 2103 “currently healthy” patients, i.e. without previous cardiovascular episodes, with suspected coronary artery disease. “At Monzino we have recruited 270, the highest number for a single center – he says Andrea Baggianohead of the Monzino Cardiovascular MRI Unit and referent for the recruitment of PRECISE patients”.
Participants were randomized into two arms, comparing two different diagnostic approaches: one arm applied the traditional approach, which requires each doctor to choose one or more of the different score clinicians used internationally for stratification (i.e. attribution of the patient to a specific risk class) and then prescribes, at its discretion, a series of functional tests, which can range from stress tests and stress echocardiography to coronary angiography.
The other arm followed the precision approach, which instead requires all clinicians to apply a single clinical score (PMRS) and use it to decide what to do. “If the PMRS was low, the patient did nothing, if he was high, he underwent a cardiac CT scan and, if necessary, the CT data were also analyzed with FFRCT – comments the expert”.
The results of the study demonstrated that in the arm followed with the precision approach, patients had a 65% reduced probability of myocardial infarctions, deaths and performing unnecessary invasive tests compared to patients in the traditional arm. According to Pontone, “after the Precise and the consolidation of the role of advanced imaging in the diagnosis of coronary disease, the new frontier is that of the use of these techniques to guide the treatment by clearing the use of non-invasive imaging in the arena of interventional therapies”.
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