Call for More Angiograms

More angiogram testing needs to be performed in order to prolong and save the lives of individuals living with coronary artery disease, according to a recent Canadian study.

The study demonstrates that the more clinicians order cardiac catheterizations (angiograms) to identify individuals with coronary artery disease, the more individuals are being identified who have high-risk blockages and who would benefit from therapeutic treatment, such as angioplasty and bypass surgery. "We're not doing enough to test people in Alberta, and as Alberta is among the leading provinces in Canada in performing angiograms per capita, we can safely say that we need to be doing a lot more of these procedures across the country,” said Dr. Michelle Graham, a cardiologist at the University of Alberta (Canada) and lead author of the study, which was published in the July 12, 2005, issue of the Canadian Medical Association Journal.

According to the study, a median of 525 men and 240 women per 100,000 in Alberta received angiograms each year between 1995 and 2002. "We would like to see much higher rates of testing in both men and women,” said Dr. Graham. "We haven't yet reached the optimal rate, but we will know when we do because the rate of testing and the rate of high-risk disease detections will level off--we haven't seen that yet.”

The study also demonstrated that of the individuals who received angiograms and were in the high-risk category, approximately 75% were eligible to receive potentially life-saving bypass surgery or angioplasty. Dr. Graham noted, however, that it is important to make sure that every patient who receives an angiogram really needs one. The procedure, which involves injecting a patient's coronary arteries with contrast agents that are tracked with imaging scanners, can have risks. Possible complications include stroke, heart attack, and even death. Furthermore, the procedure is also costly, because of the specialized equipment and need for trained personnel.

"It's a challenge, because the risks and costs associated with angiograms are such that you don't want to test everyone--you only want to test patients who have the appropriate indications for the procedure. But, even still, our research shows that we need to be performing more of them to detect and save those people who are at risk,” stated Dr. Graham.

Dr. Graham stated that Canada is about in the middle of developed nations in terms of angiograms prescribed per capita (with the United States prescribing by far the most), so there are many other countries worldwide where increased use of angiograms would result in more high-risk individuals being detected and consequently treated.

Dr. Graham and coworkers were able to compile their data through access to a comprehensive database managed by the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) project, and a group of scientists at the University of Alberta and the University of Calgary (Canada). "We are uniquely positioned to do this research in Alberta thanks to the APPROACH database,” noted Dr. Graham. "And now we are seeing the other provinces, and even countries, follow suit and create similar databases of their own.”




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