This study is being conducted in the offices of primary care physicians and cardiologists rather than in EDs. PROMISE has clinical endpoints as its primary outcomes. The study hypothesis is that intervening in patients identified as having nonobstructive CAD will yield improved outcomes. Results remain several years off, Dr. Kramer said.
ED physicians are eager for high-tech help in quickly and reliably ruling out ACS. Acute chest pain accounts for more than 8 million ED visits annually, but in only 1.19 million admissions for ACS.
Besides MPI and CTA, the other two noninvasive imaging technologies available for use in the ED are cardiac magnetic resonance (CMR) and contrast echocardiography. Neither utilizes radiation – a big plus. Yet neither is as widely used as MPI or CTA. That’s because magnetic resonance takes longer than CTA does, and the scanner may not be available at a moment’s notice, as it really needs to be, when a patient presents with chest pain to the ED. Also, expertise in CMR is not widely available. This is also an issue for contrast echo in the ED.
"The problem with contrast echo is that there are really very few centers around the world that can do it well. It really hasn’t caught on in terms of utilization in the ED," according to the cardiologist.
He reported that he serves as a consultant to Synarc and receives research support from Siemens Medical Solutions.