Thursday, January 19, 2006

Angiograms: Thumbs up or thumbs down

Please read our disclaimer.

The original inspiration for this blog was from Malaysian Medical Resources who linked to one of the articles published in The Star. Ptca.US also linked to The Star article. As such this blog is largely experimental to see if it's a useful tool.

In response to the MMR post someone asked in comments:

Question. Should angiogram be done on patients (with ischaemic heart disease) who are firmly decided not to proceed with “angioplasty” or “By-Pass surgery”?

This was the doctor's reply:

We do angiogram for diagnosis (to get an exact roadmap, of the disease process) so that we can then estimate the short and longterm outcome. This information is often not available through all the non-invasive test that we now have (will deal with MSCT later).

Whether you want surgery, or not, or you wish to go for sinseh (ED: Chinese traditional doctor) treatment, it is very unwise to make up your mind before knowing the extent of disease. Some coronary artery disease extent can cause you to have a 70% mortality in one year (meaning that without proper treatment, 7 out of 10 will die within one year), if you get what I mean. If knowing that, you still decide against surgery or angioplasty, then, I wish you luck. Why is it we often hear of people dropping dead on the golf course, collapsing while going to work, or dying suddenly in their cars?

Now for the MSCT question, well 64-slice CT as I have written in an earlier STAR article has a 97% negative predictive value and a 92-95% positive predictive value. Meaning that it is excellent for telling us that you have no disease (if your scan is normal) but if your scan shows "blockages", we are only 9 out of 10 times certain that there is something wrong.

Note that this is in established academic American labs that have done correlations not in over-night set-ups, after a 2 weeks crah course in MSCT angio interpretations. We count these as business ventures, and not necessarily, “good centers” whose data we can rely on. One day after X-number of years of "trial and error", they will eventually become good. But I pity those being tried upon in the meantime, and it is not cheap either.

The only MSCT center doing correlation to see their standards, is the one in Sarawak GH. Ask Dr Sim Kui Hian at Sarawak GH and he will tell you what their learning curve is like. Also, the MSCT is still not acceptable as a conclusive angiogram, pre CABG. The cardiac surgeon will still like a formal coronary angiogram, to see the distal run off and where to place their grafts.

Sorry folks, coronary angiogram will still be around for awhile. By the way, did you hear that the 128 slice MSCT is out, and the 256-slice MSCT proto-type is being shown at trade shows?? All the best to the MSCT folks.

Cheerio, hope this little piece helps.
Dr Ng Swee Choon
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