Implementation of coronary computed tomography angiography as nationally recommended first-line test in patients with suspected chronic coronary syndrome: impact on the use of invasive coronary angiography and revascularization. (5th September 2020)

• Record Type: Journal Article
• Authors: Nissen, Louise; Winther, Simon; Schmidt, Morten; Rønnow Sand, Niels Peter; Urbonaviciene, Grazina; Zelechowski, Marek Wojciech; Christensen, Martin Kirk; Busk, Martin; Lambrechtsen, Jess; Diederichsen, Axel; Elpert, Frank-Peter; Grove, Erik Lerkevang; Bøtker, Hans Erik; Bøttcher, Morten
• Is Part Of: European heart journal. Volume 21:Number 12(2020)
• Page Start: 1353
• Page End: 1362
• Publication Date: 2020-09-05
• Subjects: coronary computed tomography a -- ngiography -- coronary -- artery disease -- coronary angiography -- myocardial revascularization -- epidemiology; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa197
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims : To investigate the impact of applying coronary computed tomography angiography (CCTA), as the recommended first-line diagnostic test in patients with suspected chronic coronary syndrome (CCS) on the use of invasive coronary angiography (ICA) and revascularization practice. Methods and results : We included all patients undergoing a first-time CCTA ( n = 53555) and first-time ICA ( n = 41451) from 2008 to 2017 due to suspected CCS in Western Denmark (3.3 million inhabitants). The number of CCTA procedures increased from 352 (2008) to 7739 (2017) (2098%), ICA examinations declined from 4538 to 3766 (17%). The average proportion of no- or non-obstructive coronary artery disease by CCTA was 77.5%. Referral to ICA after CCTA occurred in 16.9% of patients in 2008–10 vs. 13.9% in 2014–17 ( P < 0.0001). Revascularization in patients referred to ICA after CCTA increased from 33.8% in 2008–10 vs. 44.4% in 2014–17 ( P < 0.0001). The revascularization proportion in patients undergoing ICA with no preceding CCTA was 32.3% in 2008–10 vs. 33.3% in (2014–17) ( P = 0.1063). Stratified by age, the overall revascularization proportion increased in the younger age groups and was unchanged or decreased in older age groups: <50 years: 60% increase, 50–59 years: 33% increase, 60–69 years: 0%, and >70 years: 9.5% decrease. Conclusion : The introduction of CCTA as a first-line diagnostic test in patients with suspected CCS does not associate with increased use of invasive angiography and seems to have facilitated a more appropriate revascularization practice.