Testing options for heart problems

YOU have chest pain on exertion or you have just been told that your treadmill stress test is abnormal, and you are advised to undergo a procedure called invasive coronary angiography (ICA) which involves the insertion of specially designed plastic tubes through your leg artery to take pictures of your heart arteries using iodine based contrast media under X-ray imaging. ICA is one of the most commonly performed diagnostic tests for patients suspected to have heart disease. In light of the advances in imaging of the heart arteries over the last decade, is ICA, which has been the "gold" standard for imaging of the heart arteries, still the best choice for you?

The updated July 2014 American College of Cardiology and American Heart Association guideline for the diagnosis and management of patients with stable heart disease due to blockage of the heart artery provides answers to this question. The irony is that although ICA has been performed for decades, there is as yet no strong scientific data to provide the basis for recommending an ICA. Furthermore, the guideline states that the potential additional benefit of confirming the presence or absence of blockage of heart arteries by ICA has yet to be confirmed by well designed studies. Hence, the guideline states that there is no strong evidence to support the routine recommendation of ICA for those with suspected blockage of heart arteries. ICA has been the "gold" standard by virtue of the fact that it was the only method that could allow the visualisation of the heart arteries in the past. It was basically a case of Hobson's choice. The advancing tide of technology has gradually eroded the value of ICA as a diagnostic tool for heart artery disease in the last decade as seen through the evolution of safer non-invasive methods to visualise the heart arteries, namely the use of computed tomography (CT) scan and magnetic resonance imaging (MRI).

Weighing options