Preliminary findings from the Evaluation of Integrated Cardiac Imaging (EVINCI) study show that better use of noninvasive screening could avoid unnecessary and costly invasive procedures in up to 75 % of patients with chest pain symptoms.

Most patients with suspected coronary artery disease (CAD) in Europe and the US undergo invasive procedures without first having preliminary effective noninvasive screening. But obstructive coronary disease is present in less than 40 % of patients undergoing invasive angiography.

This highlights the need for “better selection of high risk patients by non invasive means to avoid costly, risky and inappropriate invasive procedures,” said study co-coordinator Danilo Neglia from the Italian National Research Centre Institute of Clinical Physiology in Pisa, Italy.

The 3-year EVINCI study was conducted to define the most cost-effective strategy for diagnosing patients with suspected CAD. The researchers recruited a total of 695 patients with chronic chest pain and a 60 % average probability of having CAD. Patients were selected from 17 clinical centers in Europe and were aged between 30 and 75 years.

All study participants underwent integrated noninvasive diagnostic testing, largely based on cardiac imaging. After noninvasive screening, patients underwent heart catheterization when appropriate as a reference method to define the presence, extent, and functional relevance of coronary disease.

The primary endpoint was the ability of noninvasive imaging techniques to diagnose the presence of CAD in each patient, to determine if it primarily involves the major coronary arteries or the microvessels, and whether the disease is causing ischemia.

The preliminary EVINCI findings, which were completed on 15 June, show that in patients with stable angina or angina-like symptoms, the probability of significant CAD, based on clinical and stress electrocardiogram evaluation, is currently “largely overestimated.”

Indeed, the average estimated probability of disease in the study population was 60 %, while the actual prevalence of significant CAD was only 25 %.

Once the final analysis is completed, it is expected that the study will demonstrate that performing adequate noninvasive imaging screening of patients with suspected CAD could safely avoid invasive procedures in 75 out of 100 patients. The researchers predict that performing noninvasive diagnostic imaging tests in these patients could save money and be safer for patients.

Costs, potential risks of each procedure, and patients’ perception of health status are being evaluated in a health economic analysis comparing each diagnostic strategy. The final results on major endpoints are expected in a few weeks.

By Nikki Withers