Original Title: Application 1237

Authors' results and conclusions: For population 1 (patients presenting with symptoms consistent with stable ischaemic heart disease (IHD) and with an intermediate pre-test probability of coronary artery disease (CAD)) - Accuracy and safety - Stress perfusion cardiac magnetic resonance imaging (SP-CMR) and late gadolinium enhancement (LGE) is marginally safer, but less accurate, and less preferred by patients than computed tomography coronary angiography (CTCA). However, CTCA is not listed on the Medicare Benefits Schedule (MBS) for use in patients with the risk of CAD over 45%, due to lack of cost-effectiveness in intermediate to high-risk patients. SP-CMR and LGE appears to have similar accuracy to pharmacological stress echocardiography (Echo) but is not as safe. SP-CMR and LGE has similar safety but may be slightly more accurate than single-photon emission computed tomography (SPECT). Exercise electrocardiography (ECG) is very safe but is too inaccurate to be informative. Change in management - Non-invasive imaging may allow 20% - 25% of patients suspected of having CAD to avoid having an invasive coronary angiography (ICA) by ruling out those who are unlikely to be at risk of cardiac events. The only study that compared SP-CMR against the other non-invasive imaging modalities found no significant differences in the way that patients were managed, or fared, between imaging techniques. For population 2 (patients with an existing diagnosis of significant CAD who have a history of IHD and left ventricular dysfunction, and are being considered for revascularisation) - Therapeutic effectiveness - One good-quality randomised controlled trial was identified, which showed that when patients with and without viability were randomised to medical therapy or revascularisation, there were no significant differences between treatments in either the viability or non-viability arms. Therefore, regardless of the accuracy of LGE-CMR for ruling out viability using this information to guide whether patients are revascularised or not does not appear to reduce the risk of major adverse cardiac events. Assessment of viability cannot therefore be considered to be effective.

Project Status: Completed

URL for project: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1237-public

Year Published: 2016

URL for published report: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/630D10F336635665CA25801000123BDA/$File/1237-AssessmentReport-Final.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)