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Coronary artery disease (CAD) is one of the most important chronic comorbidities in the general population, resulting in tremendous societal cost.1 It is responsible for an annual death toll of 4 000 000 throughout 28 European Union (EU) member states, of which 700 000 occur at an age younger than 65 years.2 Despite significant efforts to identify novel biomarkers, genome-wide-associated studies and conventional imaging modalities, the challenge of developing effective screening tools has still to be tackled in a sufficiently resourceful manner.1
Wider availability of diagnostic machinery, as well as their partial support by guidelines, has made some procedures such as adenosine stress cardiac magnetic resonance (CMR) very popular.3 ,4 With thoughtful application, adenosine stress CMR can offer clinically relevant prognostic information and affect subsequent therapeutic decisions. However, when used to screen for CAD, stress CMR is a questionable practice. If you consider that the effects of negative stress CMR perfusion on rates of long-term major adverse cardiovascular events are very similar to those accomplished by treadmill testing, the cost-efficiency of the former is debateable.3
If we were to try to screen the EU population for high-risk cases—theoretically and effectively covering 1.6 million people expected to have acute coronary syndrome (ACS) during the next year—and if this were to be undertaken by five CMR centres per 28 EU member states, each performing 10 …
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