‘Tricky questions’ to answer before patients undergo catherization

PHILADELPHIA — The decision to send a patient for catherization can be a difficult one, a speaker at the American College of Physicians Internal Medicine acknowledged.

“To cath or not to cath, that is a tricky question,” Sammy Elmariah MD, MPH, director of interventional structural heart disease at the VA Boston Healthcare System and assistant professor at Harvard Medical School, told attendees.

“The answer should be based on a risk stratification model ... that includes the likelihood that obstructive coronary artery disease is causing the problem or the patient suffering a myocardial infarction, heart failure or dying.”

He also discussed two types of catherization therapy included in American Heart Association/American College of Cardiology guidelines.

The first, invasive therapy, provides “major advantages” including the “rapid and definitive nature” of the patient’s evaluation, potential prevention of further complications from acute coronary syndrome, and the patient is usually discharged from the hospital earlier,” Elmariah said, adding that patients most likely to benefit from the immediate type of invasive therapy are those with fractured angina or signs of heart failure.

The second type of catherization Elmariah discussed was ischemia-guided therapy.

The decision to send a patient for catherization can be a difficult one, a speaker at the American College of Physicians Internal Medicine acknowledged.

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“Major advantages” to this option include the possibility a patient’s condition stabilizes and the risks and costs associated with coronary angiography revascularization may be avoided.

Physicians that suggest the ischemia-guided treatment have to take at least one extra clinical step with their patients, according to Elmariah.

“You must perform a noninvasive stress evaluation to check for severe ischemia, since this condition can occur in patients with low stress levels,” he said. – by Janel Miller

Reference:

Elmariah S. “Acute coronary syndrome management: When the clock is ticking on the ticker.” Presented at: American College of Physicians Internal Medicine Meeting; April 11-13, 2019; Philadelphia.

Disclosures: Elmariah reports receiving research grants and contracts from Edwards Lifesciences and serving as a consultant to AstraZeneca and the Baim Institute.