Safe Deferral of Coronary Computed Tomography Angiography for Patients With a Low Pretest Probability of Coronary Artery Disease in 2019 European Society of Cardiology Guidelines
Background Coronary computed tomography angiography is increasingly used as the first‐line test for suspected coronary artery disease. Its overuse in a low pretest probability (PTP) population may lead to low diagnostic yield without change in patient management. We evaluated the clinical consequenc...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.029933 |
| _version_ | 1797403630381301760 |
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| author | Ville Varho Valtteri Uusitalo Satu M. Vaara Suvi Syväranta Helena Rajala Juha Sinisalo |
| author_facet | Ville Varho Valtteri Uusitalo Satu M. Vaara Suvi Syväranta Helena Rajala Juha Sinisalo |
| author_sort | Ville Varho |
| collection | DOAJ |
| description | Background Coronary computed tomography angiography is increasingly used as the first‐line test for suspected coronary artery disease. Its overuse in a low pretest probability (PTP) population may lead to low diagnostic yield without change in patient management. We evaluated the clinical consequences of the updated 2019 European Society of Cardiology (ESC) chronic coronary syndromes guidelines’ PTP estimation and whether imaging could be safely deferred in patients with a low PTP. Methods and Results This retrospective cohort included all 1753 consecutive patients who underwent coronary computed tomography angiography for suspected coronary artery disease at Helsinki University Hospital between 2009 and 2017. PTP was calculated according to the 2013 and 2019 ESC guidelines. The overall mortality, cardiac deaths, myocardial infarctions, and hospitalizations for unstable angina were acquired from national registry data for 1 to 10 years of follow‐up (median, 4 years). Updated 2019 ESC guidelines classified 72% of the patients as having low PTP, whose imaging could have been deferred. The revascularization rate (4.7%) and annual cardiac mortality (0.4%) were low in the 857 patients reclassified from the recommendation to test, according to the 2013 ESC guideline, to deferral of coronary computed tomography angiography, according to the new 2019 guideline. Conclusions The updated 2019 ESC guideline PTP score aids clinicians in safely preventing the overuse of cardiac imaging in patients deemed at low PTP of coronary artery disease. Diagnostic yield, revascularization rate, and cardiac mortality are low in patients with low pretest risk. |
| first_indexed | 2024-03-09T02:42:09Z |
| format | Article |
| id | doaj.art-41875651b164437cab2f09ad300bc1b3 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-09T02:42:09Z |
| publishDate | 2023-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-41875651b164437cab2f09ad300bc1b32023-12-06T02:49:39ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-12-01122310.1161/JAHA.123.029933Safe Deferral of Coronary Computed Tomography Angiography for Patients With a Low Pretest Probability of Coronary Artery Disease in 2019 European Society of Cardiology GuidelinesVille Varho0Valtteri Uusitalo1Satu M. Vaara2Suvi Syväranta3Helena Rajala4Juha Sinisalo5Cardiology, Heart and Lung Center Helsinki University Hospital and University of Helsinki Helsinki FinlandClinical Physiology and Nuclear Medicine, Diagnostic Center Helsinki University Hospital and University of Helsinki Helsinki FinlandRadiology, Diagnostic Center Helsinki University Hospital and University of Helsinki Helsinki FinlandRadiology, Diagnostic Center Helsinki University Hospital and University of Helsinki Helsinki FinlandCardiology, Heart and Lung Center Helsinki University Hospital and University of Helsinki Helsinki FinlandCardiology, Heart and Lung Center Helsinki University Hospital and University of Helsinki Helsinki FinlandBackground Coronary computed tomography angiography is increasingly used as the first‐line test for suspected coronary artery disease. Its overuse in a low pretest probability (PTP) population may lead to low diagnostic yield without change in patient management. We evaluated the clinical consequences of the updated 2019 European Society of Cardiology (ESC) chronic coronary syndromes guidelines’ PTP estimation and whether imaging could be safely deferred in patients with a low PTP. Methods and Results This retrospective cohort included all 1753 consecutive patients who underwent coronary computed tomography angiography for suspected coronary artery disease at Helsinki University Hospital between 2009 and 2017. PTP was calculated according to the 2013 and 2019 ESC guidelines. The overall mortality, cardiac deaths, myocardial infarctions, and hospitalizations for unstable angina were acquired from national registry data for 1 to 10 years of follow‐up (median, 4 years). Updated 2019 ESC guidelines classified 72% of the patients as having low PTP, whose imaging could have been deferred. The revascularization rate (4.7%) and annual cardiac mortality (0.4%) were low in the 857 patients reclassified from the recommendation to test, according to the 2013 ESC guideline, to deferral of coronary computed tomography angiography, according to the new 2019 guideline. Conclusions The updated 2019 ESC guideline PTP score aids clinicians in safely preventing the overuse of cardiac imaging in patients deemed at low PTP of coronary artery disease. Diagnostic yield, revascularization rate, and cardiac mortality are low in patients with low pretest risk.https://www.ahajournals.org/doi/10.1161/JAHA.123.029933cardiac imagingchest painchronic coronary syndromediagnostic yieldprognosis |
| spellingShingle | Ville Varho Valtteri Uusitalo Satu M. Vaara Suvi Syväranta Helena Rajala Juha Sinisalo Safe Deferral of Coronary Computed Tomography Angiography for Patients With a Low Pretest Probability of Coronary Artery Disease in 2019 European Society of Cardiology Guidelines Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac imaging chest pain chronic coronary syndrome diagnostic yield prognosis |
| title | Safe Deferral of Coronary Computed Tomography Angiography for Patients With a Low Pretest Probability of Coronary Artery Disease in 2019 European Society of Cardiology Guidelines |
| title_full | Safe Deferral of Coronary Computed Tomography Angiography for Patients With a Low Pretest Probability of Coronary Artery Disease in 2019 European Society of Cardiology Guidelines |
| title_fullStr | Safe Deferral of Coronary Computed Tomography Angiography for Patients With a Low Pretest Probability of Coronary Artery Disease in 2019 European Society of Cardiology Guidelines |
| title_full_unstemmed | Safe Deferral of Coronary Computed Tomography Angiography for Patients With a Low Pretest Probability of Coronary Artery Disease in 2019 European Society of Cardiology Guidelines |
| title_short | Safe Deferral of Coronary Computed Tomography Angiography for Patients With a Low Pretest Probability of Coronary Artery Disease in 2019 European Society of Cardiology Guidelines |
| title_sort | safe deferral of coronary computed tomography angiography for patients with a low pretest probability of coronary artery disease in 2019 european society of cardiology guidelines |
| topic | cardiac imaging chest pain chronic coronary syndrome diagnostic yield prognosis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.029933 |
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