The number of patients with coronary heart disease in China is 11.39 million, and its incidence rate and mortality rate are increasing year by year. The annual medical expenditure is more than 100 billion yuan.

The diagnosis of coronary heart disease includes invasive coronary angiography (coronary angiography) and non-invasive electrocardiogram, cardiac ultrasound, cardiac CT, and nuclear medicine myocardial perfusion imaging (MPI), etc., to guide clinical determination of treatment plans. The treatment of coronary heart disease includes invasive interventions (stents, balloons), surgical bypass surgery, and non-invasive drug therapy. For patients with acute coronary syndrome, timely coronary angiography and stent treatment can save their lives; For stable coronary heart disease patients, non-invasive examination is required to distinguish whether there is myocardial ischemia and the degree of ischemia. If there is no myocardial ischemia or mild ischemia, no coronary angiography is required to discharge the patient; Patients with moderate to severe myocardial ischemia can benefit from coronary angiography and stenting.

More than 5 million coronary heart disease patients in China undergo invasive coronary angiography every year, of which 1.2 million (25%) undergo interventional treatment. That is to say, the remaining 3.8 million (75%) patients have normal or mild abnormalities in coronary angiography. These patients can completely avoid invasive coronary angiography through non-invasive examinations such as nuclear medicine MPI. Among the 1.2 million patients who received interventional treatment, about 200000 did not have severe myocardial ischemia, which means that these 200000 cases can also avoid coronary angiography and stent implantation through non-invasive MPI examination.

According to statistics, the average hospitalization expenses for each patient undergoing interventional treatment, simple coronavirus infection, and simple nuclear medicine MPI are 13800 yuan, 8200 yuan, and 4700 yuan, respectively.

If the 200000 interventional treatment patients mentioned above (medical expenses of 2.76 billion yuan, excluding the cost of long-term use of anticoagulant drugs after discharge) undergo non-invasive MPI examination first (940 million yuan), medical expenses can be saved by 66% (1.82 billion yuan); If the 3.8 million COVID-19 patients mentioned above (31.2 billion yuan) undergo MPI examination first (17.9 billion yuan), medical expenses can be saved by 43% (13.3 billion yuan).

Studies have shown that stable coronary heart disease patients who do not undergo nuclear medicine MPI examination but directly undergo coronary angiography and interventional treatment have four times more stents placed. At the same time, patients not only do not benefit, but also have a four fold increase in myocardial infarction and nearly two times more deaths. The mortality rate of interventional treatment for coronary heart disease in China is 0.38% (the 200000 cases mentioned above resulted in 760 deaths), the mortality rate of COVID-19 is 0.08% (the 3.8 million cases mentioned above resulted in over 3000 deaths), and the mortality rate of non-invasive examination methods is almost zero.

To avoid excessive diagnosis and treatment, the Cardiovascular Disease Branch of the Chinese Medical Association and the Nuclear Medicine Branch of the Chinese Medical Association have both developed relevant clinical guidelines and expert consensus, emphasizing the importance of non-invasive examination for stable coronary heart disease, in order to guide and standardize clinical precision diagnosis and treatment plans. Due to the lack of legal validity of guidelines and expert consensus, there are still quite a few clinical doctors who choose coronary angiography or interventional treatment first without specifying the degree of myocardial ischemia in patients, resulting in unnecessary coronary angiography and interventional treatment for patients without myocardial ischemia or with less severe ischemia. This not only increases the mental and physical suffering of patients, but also increases unnecessary medical expenses, and some patients even pay the price of their lives for it.

Data shows that approximately 8 million related patients in the United States undergo nuclear medicine MPI examinations every year, with a population of 23 million in Taiwan Province and 150000 cases per year, while in mainland China, there are only 100000 cases per year with a population of 1.4 billion. To avoid excessive diagnosis and treatment of coronary heart disease patients, some countries and regions have introduced relevant medical insurance policies, stipulating that stable coronary heart disease patients must first undergo non-invasive examinations for myocardial ischemia evaluation to determine whether coronary angiography and interventional treatment are necessary. Otherwise, medical insurance will not be reimbursed.

Based on the high incidence of coronary heart disease in China, the existence of excessive diagnosis and treatment, and unreasonable medical expenses, it is recommended that relevant management departments introduce relevant policies, regulate medical behavior, and make reasonable use of medical resources. For stable coronary heart disease patients, non-invasive examinations (especially nuclear medicine MPI) should be conducted before coronary angiography and intervention treatment to determine whether there is myocardial ischemia and the degree of ischemia, and then determine whether patients need coronary angiography and intervention treatment. For those who have not undergone myocardial ischemia assessment but directly undergo coronary angiography and interventional treatment, medical insurance will not reimburse the relevant expenses. This not only avoids excessive diagnosis and treatment, reduces the mental and economic burden on patients and families, but also saves a lot of medical insurance funds for the country.