Coronary Angiograms May Be Overused, Study Says - WSJ.com

Coronary Angiograms May Be Overused, Study Says - WSJ.com By RON WINSLOW

A widely used test to detect blockages in the heart's arteries often turns up little or no evidence of disease, a new study found, suggesting that patients are frequently exposed unnecessarily to the risks and costs of the invasive examination.

The test is a called a coronary angiogram, in which cardiologists thread a catheter into the heart to take an X-ray movie to look for obstructions that might cause chest pain or increase the risk of a heart attack. More than a million U.S. patients undergo the diagnostic test each year at a cost of about $10,000 each, according to government data. In cases where significant obstruction is found, the test helps doctors determine whether a patient should undergo coronary bypass surgery or have a stent implanted to alleviate the problem.

The new study, published in this week's New England Journal of Medicine, is based on data on nearly 400,000 angiograms performed between 2004 and 2008 that 633 hospitals in the U.S. submitted to a registry maintained by the American College of Cardiology. The patients weren't previously diagnosed with heart disease, but because of symptoms, family history or other reasons ended up getting the test. Such patients represent about 20% of all people who are referred for angiograms, researchers said.

The study found that 62% of the patients didn't have evidence of significant obstructions, while 38% had important blockages, researchers found. In all, 39% were determined not to have coronary-artery disease.

"The rate of obstructive disease isn't as high as we had hoped," said Manesh Patel, a cardiologist at Duke University's Duke Clinical Research Institute, who led the study. "Our process of diagnosing coronary artery disease needs improvement."

Dr. Patel and other cardiologists cautioned that the results don't apply to patients with established disease or, especially, with severe chest pain where there is concern for an imminent heart attack. For such patients, getting an urgent angiogram can be a crucial step in treatment.

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The study also comes amid growing concern about the exploding use of radiation-based imaging in medicine, which has sparked worries that many patients are electing to get scans that provide little benefit while increasing their risk of cancer. ...