Monday, March 16, 2015


The American College of Cardiology is holding their Annual Scientific Meeting in San Diego, California now ( 14-16th March 2015 ). One of the papers presented on Day 1 was an interesting study of the use of CTA in the evaluation of new onset  Chest Pains. Dr Pamela Douglas of Dukes Clinical Research Unit, Durham, N Carolina led the study. This study ( importantly ) was NHLBI funded. Is was also simultaneously published in the latest issue of the New England Journal of Medicine.Dr Douglas and colleagues studied 10,003 patients with new onset chest pains, and divided them into two arms. One arm ( 4,996 pts ) received a CTA for evaluation and the other arm ( 5007 pts ) received functional stress testing including nuclear imaging and stress ECG. The primary end point was composite of death, MI, hospitalisation for Unstable angina, and risk of major procedural complications. This study was called PROMISE ( Prospective Multi-center Imaging Study for the Evaluation of Chest Pains.
After 2 years follow-up, they found that overall, the event rates were small, 3.3% in the CTA arm and 3.0 % in the functional stress testing arm. This difference were not statistically significant.
This shows that in the evaluation of new onset chest pains, more costly CTA with the additional risk of radiation did not do any better than the conventional stress testing in prediction clinically important events. There was one exception however. The use of CTA in the emergency unit, did expidite discharge from hospital, avoiding unnecessary admission. This was the first indication for CTA in the early years, if you remember.

In an unrelated piece of not so nice news from the local scene,
I heard news ( have to confirm with other sources ) that a certain politician is serious mis-using the CTA in Kuching Heart Center to do cardiac screening for assymptomatic patients as a political favour for his " constituents " without even explaining to them the serious radiation risk. It is alleged that the Hospital Director knows about it but is unable to, or doing nothing about it. These screening CTAs have no registration number, although they are using Public Hospital facilities. Some of those screened were as young as 17 years old. I do hope that the Ministry of Health will look into this. Political campaigning using public hospital facilities, using a tool which has risks to the patients is opens  a new and dangerous chapter in Malaysian politics. I do hope that the news is wrong, but investigation by the relevant authorities would certainly help to clarify the exact situation. What is more important, that this unhealthy practice be stopped. Patients must know the risk of procedures, their indications and and usefulness. Using of public facilities by politicians would mean that those patients who need those facilities, will have a longer waiting list. This is not fair. It is not lost on us, that the Sarawak State Election is coming, and so there may be a element of truth in the "rumour".

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