Presentation is loading. Please wait.

Presentation is loading. Please wait.

Rate of Obstructive Coronary Disease in Elective Diagnostic Cath Manesh R. Patel, MD Assistant Professor of Medicine Director Cath Lab Research – Duke.

Similar presentations


Presentation on theme: "Rate of Obstructive Coronary Disease in Elective Diagnostic Cath Manesh R. Patel, MD Assistant Professor of Medicine Director Cath Lab Research – Duke."— Presentation transcript:

1 Rate of Obstructive Coronary Disease in Elective Diagnostic Cath Manesh R. Patel, MD Assistant Professor of Medicine Director Cath Lab Research – Duke University Medical Center

2 Disclosures n Interventional cardiologist l Clinical Cardiovascular MRI and Vascular Ultrasound n Division of Cardiology l Majority of Revenue from cardiovascular imaging n Genzyme l Advisory Board n Chair of Writing Group for ACC/AHA Coronary Revascularization Appropriateness Criteria

3 The Challenge in Cardiology Practice

4 Patient Case - Mrs. M n 58 years old with DM n Lives independently l Shops, Cleans, works in bank n 7/08 seen by PCP l Occasional Chest “ache” with walking at grocery store l Cramping in calves n Referred to Duke Cardiology / Vascular Clinic for evaluation

5 What would you do? n How do you determine risk and identify disease? n What data do you need to determine if invasive angiography and subsequent coronary revascularization will improve here symptoms and/or longevity

6 Step 1 - How do you decide pre-test probability

7 Clinical Decision Making - Question 1 n Which is the best model to calculate pretest probability of CAD in this patient? n A. Framingham Risk Score n B. Diamond Forrester Score n C. TIMI UA/NSTEMI Score n D. GRACE Score

8 Decision Question 2 n Based on the Diamond-Forrester classification, the pretest probability of this patient having CAD is: A. Very Low B. Low C. Intermediate D. High

9 Stratifying patients with Chest pain Intermediate Probability = 10-90% ACC/AHA Chronic Stable Angina Guidelines

10 Question # 1 n In patients with intermediate pre-test probability of coronary artery disease - what cardiovascular test should be done to diagnose and risk stratify for coronary artery disease?

11 Imaging Use n Non-invasive cardiac imaging has improved assessment of cardiac function, anatomy, and pathology.

12 Imaging Use n Medicare spending on imaging services more than doubled from 2000 through 2006 Source: GAO Analysis of Medicare Data, Report GAO Dollars (billions)

13

14 How good are we at identifying obstructive CAD ? All ACC-NCDR patients who had cardiac catheterization 1,989,779 patients at 663 sites Exclude: Prior MI, PCI, CABG, Cardiac Transplant, Valve surgery 629,325 patients at 663 sites 1,148,405 patients at 663 sites Exclude: Emergent admission symptoms (AMI and ACS) and cardiogenic shock 397,954 patients at 663 sites Exclude: other diagnostic cath indications Rate of Obstructive CAD* 60.3% 36.2% 37.5% 51.7% January 2004-April 2008

15 Rate of Obstructive CAD n Obstructive CAD l ≥ 50% LM or ≥ 70% Epicardial Vessel l 38% l ≥ 50% Any vessel l 41% n Minimal CAD l < 20% stenosis in any vessel 39%entire cohort 39%entire cohort

16 Obstructive CAD Disease At Cath (NCDR data) n 397,954 patients without known CAD/MI or prior PCI/CABG undergoing diagnostic cath to R/O CAD n 59% of patients with positive non-invasive tests have no obstructive CAD on invasive angiography (False positive)

17 Obstructive CAD over time

18 ACC-NCDR Study n Current risk stratification including non-invasive testing used to inform decisions to perform angiography to identify obstructive CAD need significant improvement


Download ppt "Rate of Obstructive Coronary Disease in Elective Diagnostic Cath Manesh R. Patel, MD Assistant Professor of Medicine Director Cath Lab Research – Duke."

Similar presentations


Ads by Google