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

TY - JOUR

T1 - Implementation of coronary computed tomography angiography as nationally recommended first-line test in patients with suspected chronic coronary syndrome

T2 - impact on the use of invasive coronary angiography and revascularization

AU - Nissen, Louise

AU - Winther, Simon

AU - Schmidt, Morten

AU - Sand, Niels Peter Rønnow

AU - Urbonaviciene, Grazina

AU - Zelechowski, Marek Wojciech

AU - Christensen, Martin Kirk

AU - Busk, Martin

AU - Lambrechtsen, Jess

AU - Diederichsen, Axel

AU - Elpert, Frank Peter

AU - Grove, Erik Lerkevang

AU - Bøtker, Hans Erik

AU - Bøttcher, Morten

N1 - Publisher Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author(s) 2020.

PY - 2021/12/1

Y1 - 2021/12/1

N2 - 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 We included all patients undergoing a first-time CCTA (n = 53555) and first-time ICA (n = 41451) from 2008 to results 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.

AB - 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 We included all patients undergoing a first-time CCTA (n = 53555) and first-time ICA (n = 41451) from 2008 to results 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.

KW - Artery disease

KW - Coronary

KW - Coronary angiography

KW - Coronary computed tomography a

KW - Epidemiology

KW - Myocardial revascularization

KW - Ngiography

UR - http://www.scopus.com/inward/record.url?scp=85097003930&partnerID=8YFLogxK

U2 - 10.1093/ehjci/jeaa197

DO - 10.1093/ehjci/jeaa197

M3 - Journal article

C2 - 32888290

AN - SCOPUS:85097003930

SN - 2047-2404

VL - 21

SP - 1353

EP - 1362

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

IS - 12

ER -