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Multimodality cardiac imaging trials in CAD: viewpoints “across the ocean"



This was the first joint session to be held at this meeting that is co-sponsored by the American Society of Nuclear Cardiology (ASNC). The 4 speakers addressed all recent cardiac imaging-related trials with focus on clinical implications in daily practice.
The session took a tour de force by Dr. Danilo Neglia from a leading Italian European trial (EVINCI), to a review of COURAGE and PROMISE and a new risk score by Dr. Cremer that can outperform the Forester-Diamond score. In addition, we learned about the value and downstream course of testing from a presentation from the CE-MARC 1 and 2 studies. The 2 studies used SPECT, and perfusion MRI or later a NICE-guided management for patients presenting with possible coronary disease.
Finally, we had a review by Dr Thomas of the STICH and PARR-2 studies and their role in guiding viability testing. We learned the major shortcomings of STICH as an observational non-randomised “viability” trial utilising an outdated and inconsistent testing modality in an open label fashion, and in some but not all patients in the overall study.
The chairs and the speakers all agreed that optimal medical therapy should be the initial management of patients with suspected or confirmed coronary artery disease. Any future trial should include an optimal medical therapy arm in addition to the imaging arm(s).

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.