There are numerous methods for diagnosing coronary artery disease but until now clinical studies have mainly focused on single modalities rather than comparing different integrated strategies. "We have a multiple array of methodologies that can be chosen according to guidelines and recommendations," says EVINCI coordinator Dr Danilo Neglia (Pisa, Italy). "We do actually know the strengths and weaknesses of each technique but there is no clue as to which approach is the most cost effective to solve the diagnostic issue and define proper treatment in the single patient."
The EVINCI study enrolled 695 patients with chronic chest pain and a 60% average probability of having coronary artery disease. Patients were aged 30-75 years and 38% were female. Patients were selected from 17 clinical centres in Europe and underwent integrated non-invasive diagnostic testing, largely based on cardiac imaging. After non-invasive screening, patients underwent heart catheterization (coronary angiography and functional measurements) when appropriate as a reference method to define the presence, extent and functional relevance of coronary disease (i.e. its effects in limiting coronary flow reserve). The different non-invasive strategies were compared for their diagnostic accuracy, and the costs and potential risks were monitored. This study design is in line with the push to perform comparative effectiveness research in Europe.
The major endpoint of EVINCI was to assess the ability of non-invasive multimodality imaging to diagnose the presence of coronary artery disease in the single patient, determine if it primarily involves the major coronary arteries or the microvessels, and whether the disease is causing ischaemia which needs aggressive treatment. This is relevant because knowing the extent and the functional relevance of the disease helps to determine whether treatment is likely to improve prognosis and quality of life. In this way unnecessary treatments
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European Society of Cardiology