Cost-Effectiveness for imaging stable ischemic disease.

Stable ischemic heart disease (SIHD) remains a major cause of morbidity and mortality. Although there are multiple imaging modalities to diagnose and/or assist in the clinical management, the most cost effective approach remains unclear. We reviewed the relevant and recent evidence based clinical studies and trials to suggest the most cost effective approach to SIHD. The limitations of these studies are discussed. Incorporating the results of recent multicenter trials, we suggest that for appropriate patients with Coronary Artery Disease (CAD) with any degree of stenosis or presence of coronary calcium, Optimal Medical Therapy (OMT) may be most cost-effective. Invasive Coronary Angiography (ICA) and/or coronary revascularization would be primarily for non-responders or >/=50% left main (LM) stenosis. Stress Cardiac Magnetic Imaging (sCMR) would be performed for those patients with non-diagnostic coronary CT angiography (CCTA) from motion and non-responders from OMT in non-diagnostic CCTA group from high coronary calcium. These paths seem to be safe and cost effective but requires modeling for confirmation.