CE-MARC 2 Trial Assesses Superiority of Angiography Strategies
In patients with suspected coronary heart disease (CHD), cardiovascular magnetic resonance (CMR)-guided care was shown to significantly reduce unnecessary angiography as compared to care using the UK NICE guidelines, but showed no difference from myocardial perfusion scintigraphy (MPS)-guided care, according to results from the CE-MARC 2 Trial presented Aug. 29 at ESC Congress 2016 in Rome and published simultaneously in the Journal of the American Medical Association.
The study, led by John P. Greenwood, PhD, et al., looked at 1,202 symptomatic patients with suspected CHD from six UK hospitals. The patients were randomly assigned to management according to the UK NICE guidelines, CMR-guided care or MPS-guided care. The number of patients with invasive coronary angiography after 12 months was 102 in the UK NICE guidelines group (43 percent), 85 in the CMR-guided care group (18 percent), and 78 in the MPS-guided care group (16 percent).
Results showed that the primary endpoint of protocol-defined unnecessary coronary angiography occurred in 69 patients in the UK NICE guidelines group (28.8 percent), 36 patients in the CMR-guided care group (7.5 percent), and 34 patients in the MPS-guided care group (7.1 percent); adjusted odds ratio of unnecessary angiography: CMR-guided care group vs. UK NICE guidelines group, 0.21 (95 percent CI, 0.12-0.34, P<0.001); CMR-guided group vs. the MPS-guided group, 1.27 (95 percent CI, 0.79-2.03, P=0.32).
The researchers note that there were no “statistically significant” differences in the secondary endpoint of major adverse cardiovascular event rates after 12 months.
“These results show that a broader use of functional imaging (CMR or MPS), in low, intermediate and high risk patient groups, could reduce the rates of invasive angiography that ultimately show no obstructive coronary disease,” said Greenwood. “In addition, CE-MARC and CE-MARC 2 further support the role of CMR as an alternative to MPS for the diagnosis and management of patients with suspected CHD.”
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