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Fewer clogged arteries need heart stents, study finds; blood-flow test can show which ones do
January 14, 2009
An overall good job addressing most of our criteria. But it could have done a better job explaining the role of stress testing and the reasons why the blood flow test hasn't been used more widely.
Our Review Summary
Coronary artery stenting has not been shown to prevent deaths or other adverse events compared to medical treatment in patients with stable coronary artery disease. One reason for this is that many people are given stents based on the results of coronary angiography and this test cannot predict who will benefit from the procedure and who will not. Adding an additional test at the time of angiography, the Functional Flow Reserve Test (FFR, also known as the blood-flow test) may add more information on who could benefit from the placement of a stent.
A study released in January 15th's New England Journal of Medicine found that adding FFR to conventional angiography allowed the researchers to better identify and intervene on those who are more likely to benefit from stenting. This story does a good job of describing the current study and its potential implications for clinical practice. It adequately quantifies the benefits of angiography+FFR, quotes multiple sources, does not engage in disease mongering and accurately describes the novelty of FFR.
The story could have better described the alternatives to angiography with FFR. Clearly angiography alone is the alternative to angiography + FFR. The story briefly mentions stress testing but could have done more to describe the pros and cons of these different testing strategies. Stress testing is underutilized as a first step prior to angiography and it is currently unknown what role it should play in a testing strategy that would include angiography + FFR.
Finally, the story could have done a better job explaining the availability of FFR. The story mentions that the FFR test is used in only 10% of angiographies currently. What is not clear is if that low percentage is due to lack of availability of the technology or practitioners who are trained to use it and where a consumer could expect to find it (in large, academic medical centers only, for example).
Overall, the story did a good job and addressed most of our criteria.
Click on Criteria for definitions.
The story mentions that the Functional Flow Reserve Test (FFR, also known as the blood-flow test) is used in only 10% of angiographies currently. What is not clear is if that low percentage is due to lack of availability of the technology or practitioners who are trained to use it and where a consumer could expect to find it (in large, academic medical centers only, for example)
The story adequately describes the cost of performing the test, although it could have been compared to the cost of no stenting.
The story clearly states who this test is appropriate for - those experiencing chest pain symptoms or recovering from a heart attack - and not assymptomatic individuals or those with elevated risk factors for heart disease.
The story adequately describes the design of the current study and notes that more studies are needed to confirm the results.
The story does not mention any harms of FFR. In this context, however, the potential for harms of FFR are insignificant compared to risks of angiography and stenting.
The story clearly states that FFR is not a new test but it has not been widely used.
The story quantifies the mortality rate in the angiography alone versus angiography + FFR group. The story also quantifies the number of stents placed in both groups. The story could have also highlighted the fact that FFR did not reduce the number of people getting stents in the first place.
The story quotes more than one expert, one of whom is identified as not being associated with the study. Although the content of the story is very similar to the Stanford press release, it is clear that there was enterprise reporting.
The story quotes multiple experts, including one who is identified as not being associated with the study.
Clearly angiography alone is the alternative to angiography + FFR. The story briefly mentions stress testing but could have done more to describe the pros and cons of these different testing strategies. Stress testing is underutilized as a first step prior to angiography and it is currently unknown what role it should play in a testing strategy that would include angiography + FFR.
Total Score: 8 of 9 Satisfactory
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