First-line' strategy: Computer Tomography Coronary Angiogram vs Standard Invasive Coronary Angiography

Posted 19 Mar 2021

Flinders researchers will carry out a trial on emergency department patients experiencing chest pains – by trialling a less invasive and risky diagnostic test as a ‘first-line’ strategy.

"In Australia, suspected acute coronary syndrome accounts for nearly one million emergency department (ED) presentations each year. In South Australian that equates to 30,000 episodes of care consuming 17,500 emergency bed days - yet up to 85 per cent of these patients do not have acute coronary syndrome,” Flinders Medical Centre Cardiologist, Dr Sam Lehman, explains.

When a patient with suspected acute coronary syndrome has even a low troponin level detected in their blood, a coronary angiography is the standard diagnostic test. Yet this procedure can be invasive and carries some risk, including allergic reaction, bleeding, heart attack and stroke.

The procedure involves inserting a catheter into an artery and threaded up into the heart. A contrast dye is then sent through the catheter to help the arteries show up on an x-ray and view any blockages, narrowing or abnormalities in the arteries or heart.

But Dr Lehman has received a Flinders Foundation Health Seed Grant to carry out a pilot study trialling the use of a Computer Tomography Coronary Angiogram (CTCA) as the ‘first-line’ strategy, instead of the conventional coronary angiogram.

This procedure is less invasive for the patient and involves die inserted through a vein in the arm, with more detailed pictures then taken using a combination of X-rays and computer technology.

Dr Lehman says avoiding invasive testing using a safe method could have wide-spread implications:

"Whilst CTCA is an established technology, its use as a first-line strategy in this newly identified cohort of ED presenters with low level troponin elevations would establish a critically needed novel care pathway for these individuals.”

“This pioneering study is anticipated to have widespread impact, nationally and internationally, on consumer-relevant outcomes as well as health policy and funding reforms.”

Research category: Heart Health

Project title: The Impact of First-Line CT Coronary Angiography versus Standard Invasive Coronary Angiography for Suspected Acute Coronary Syndrome Patients with Low Level Troponin Elevations; A Randomised Pilot Study.

Lead researcher: Dr Sam Lehman


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