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Moresurgeries,costsafterCTangiography:study
AgenciesPostedonline:WedNov162011,13:05hrs
NewYork:PatientswhohadaCTscantocheckforbuildupinthearteriesaroundthehearthadmoresurgeriesand
morecostlymedicalcarethanthosewhohadtheirheartscheckedwithbasicstresstests,anewstudyshowed.

Whileresearcherscouldnottellifthoseextracostlyprocedureswerereallynecessary,theysaidthefindingssuggested
thatdoctorsmaydetectsmallchangesinthearteriesonCTscansthatleadthemtodomoreinvasive,potentially
unnecessarysurgeries.

SocalledCTangiographywasdevelopedasanalternativetocoronaryangiography,whichrequiresdoctorstothreada
catheterthroughthebloodvesselstocheckforblockagesinpatientswithsignsofheartdisease.

It'sapromisingtechnologythatallowsonetoavoidtheinvasivenessof(coronaryangiography),saidColonelPatrick
O'MalleyoftheUniformedServicesUniversityinBethesda,Maryland,whowasnotinvolvedinthenewstudy.

Thetroublewiththat,though,isbecauseit'snoninvasive,ittendstogetutilizedinappropriately,headded.

Theproperutilityofthistestisinsomebodywhoissymptomaticthatyouthinkneedsacoronaryangiography,butyou
wanttoavoidtheriskofit,soyouwanttoruleoutanyclinicallysignificant(arteryblockage).Alltoooftenthey're
happeninginevenasymptomaticfolks,saidO'Malley,whohasstudiedheartimaging.

Forthestudy,researchersfromStanfordUniversityinCalifornialookedatrecordsofMedicarebeneficiarieswhohad
noninvasivetestsforcoronaryarterydiseasein2005through2008,includingmorethan280,000olderadults.Those
includedCTangiographiesandstresstestsdonewithechocardiography(ECG).

Overthesixmonthsafterpatientshadthoseteststocheckheartfunction,theresearcherstrackedanyotherheart
relatedprocedurestheyunderwentandthetotalcostoftheirmedicalcare.

Onlyaboutthreepercentofpatients,orcloseto9,000,hadaCTtesttobeginwith.Butthosepatientsweremorelikely
thanpeoplegettinganyothertypeofstresstesttolaterhaveanumberofmoreinvasivetestsandprocedures,including
cardiaccatheterization,stentingandbypassgraftsurgery.

ClosetoeightpercentofpatientshadastentinsertedintheirarteriesafteraCTangiography,comparedwithbetween
twopercentandthreepercentafterstresstests.

Asimilarnumberofpatientsgettingeachtypeoftest,aroundonepercent,diedoverthesixmonthsafterthetest.

TotalmedicalspendingrelatedtoheartcareoverthosesixmonthswasalmosttwiceashighinpatientswhohadCT
scans,atabout$15,000,thaninthosewhohadbeengivenstresstests(about$8,000).

Thethingthatworriesme...isthatit'sassociatedwithahigherincidenceofpercutaneouscoronaryintervention,andit's
alsoassociatedwithahigher(incidenceof)bypasssurgerythat'sreallydisturbing,O'Malleysaid,notingthattherewas
evidencethatbothofthoseheartprocedureswerealsodonetoofrequentlyintheUnitedStates.

WhendoctorsseebuildupinthearteriesonaCTscan,evenifitmightnotleadtoanyheartproblems,thereflexisto
stentit,headded.

SENSITIVETEST

CTangiographyisaverysensitivetest,meaningthatyou'llseeanabnormalityifit'sthere...butsometimesyou'llsee
somethinganditwillturnoutonanangiographythatit'snotreallyaclinicallyimportantproblem,saidDr.MarkHlatky,

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whoworkedonthestudy.

HesaidthatespeciallywitholderMedicarepatients,It'sprettyunlikelythatsomebodyatthatagehastotallynormal
arteries.

Hlatkysaidhesuspectedthatatleastsomeoftheextratestsandprocedureswereorderedbydoctorstosortoutthose
smallabnormalities.

Still,hesaid,Ourstudywastooshorttoreallyknowwhetherthat'sreallygoodforpatientsinthelongrunornot.Heand
hiscolleaguescouldnottell,forinstance,ifuseofCTscans,andsubsequentheartprocedures,ledtobetterhealthor
qualityoflifeforpatientsyearslater.

Currentguidelines,histeamwroteintheJournaloftheAmericanMedicalAssociation,callforastresstestformost
patients,withangiographyreservedforthosewhosestresstestindicatesproblemsorwhohavesignsofhigherheart
risks.

ThefindingswerealsopresentedthisweekattheAmericanHeartAssociationScientificSessionsinOrlando,Florida.

O'MalleysaidthatpatientsneededtobeawarethatCTangiography,eventhoughitisnoninvasive,isnotariskfree
procedure.Indeed,it'snotharmless,hesaid.Peopleneedtobemindfulthatthere'sradiationassociatedwithit.Nowit
seemslikethere'sunappreciatedriskthatitmayleadtounnecessaryinterventionsdowntheroad.

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