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ANGIOGRAPHY VIDEO: Possible Overuse of Common Heart Test (Interview with Dr. Manesh Patel, MD, Duke University)
ANGIOGRAPHY VIDEO: Possible Overuse of Common Heart Test (Interview with Dr. Manesh Patel, MD, Duke University)

(March 12, 2010 - Insidermedicine)

Less than half of individuals without known heart disease who are undergo invasive testing of the coronary blood vessels are found to have significant obstructions in these vessels, , according to research published in the New England Journal of Medicine.

Here is some information about coronary angiography:

•    It is a procedure in which dye is injected into the body and then X-rays are used to visualize blood flow through the vessels that feed the heart.

•    It is usually done along with catheterization, in which a balloon-tipped catheter is threaded into the coronary arteries to achieve a better view of the vessels and remove any blockages that are found

•    The procedure carries with it a very small risk of a serious adverse event, including a heart attack or stroke

Researchers from Duke University Medical Center in Durham used a national cardiovascular registry to identify nearly 400,000 individuals without known heart disease who underwent coronary catheterization to look for obstructions in the blood vessels that feed the heart. Left untreated, such obstructions can lead to a heart attack or stroke. The investigators also looked at whether certain characteristics of the individuals, including their sex, age, the presence of other medical conditions, and the results of less invasive tests, could predict who would eventually be diagnosed with one or more obstructions.

Catheterization revealed the presence of an obstruction in only about 38% of the individuals tested. In addition, a lack of obstructive disease was confirmed in 39% of the individuals. Men, those who were older, those with insulin-dependent diabetes, and those with high cholesterol levels were all more likely to have obstructions in their coronary arteries. Those who had positive findings on noninvasive tests were only 28% more likely to have an obstruction than those who underwent no such testing.

We spoke with Dr. Manesh Patel, one of the investigators of this study, who offered some further insight.

Today’s research highlights the need to do a better job of identifying who is likely to have obstructive coronary artery disease before sending individuals for invasive coronary angiography and catheterization.