Evaluation of the Appropriate Use of Coronary Computed Tomography Angiography: A Retrospective, Single-Center Analysis
Purpose: We assessed the application of appropriate use criteria of coronary computed tomography angiography (CCTA) in comparison to invasive coronary angiography results and revascularization rates in patients with coronary artery disease (CAD). Methods: 1305 patients referred to invasive coronary...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/9/6/180 |
| _version_ | 1797486163385122816 |
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| author | Katharina Birkl Christoph Beyer Fabian Plank Gudrun Maria Feuchtner Guy Friedrich |
| author_facet | Katharina Birkl Christoph Beyer Fabian Plank Gudrun Maria Feuchtner Guy Friedrich |
| author_sort | Katharina Birkl |
| collection | DOAJ |
| description | Purpose: We assessed the application of appropriate use criteria of coronary computed tomography angiography (CCTA) in comparison to invasive coronary angiography results and revascularization rates in patients with coronary artery disease (CAD). Methods: 1305 patients referred to invasive coronary angiography (ICA) after CCTA were evaluated retrospectively. The primary indication for CCTA was assessed according to the consensus for intermediate-risk (15–85% pre-test probability) into appropriate (A), inappropriate (I), and uncertain while referring to published guidelines. Patients’ risk factors, angina, and heart failure symptoms (Canadian Cardiovascular Society classification (CCSC), New York Heart Association (NYHA); clinical data; and ICA results were gathered. Results: Of 1305 patients referred to CCTA prior to ICA, 496 (38.0%) were appropriate, 766 (56.9%) inappropriate, and 43 (3.3%) uncertain. Of 766 patients with inappropriate CCTA referrals, 370 (48.3%) were classified as “inappropriately low” (<15% pre-test probability) and 396 (51.7%) as “inappropriately high” (>85%) in regard to the recommended CCTA utilization. Sub-analysis of the adherence to the appropriate use criteria did not differ between the source of the referring physicians (intramural tertiary, private practice primary care, or external secondary care hospitals). Obstructive CAD with subsequent revascularization rates (total of 39.2%) did not differ significantly between the appropriate (38.3%), inappropriate (41.0%), or uncertain (23.3%) groups (<i>p</i> = 0.068). Conclusion: The total coronary revascularization rate after CCTA was 39.2% and not different among low, intermediate, and pre-test probability groups. These findings support the role of CCTA as an excellent gatekeeper in patients with suspected obstructive CAD even beyond pre-test probability calculation models. |
| first_indexed | 2024-03-09T23:29:17Z |
| format | Article |
| id | doaj.art-79c4ae42885a44a9a927d9e6ded65500 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-09T23:29:17Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-79c4ae42885a44a9a927d9e6ded655002023-11-23T17:12:33ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252022-06-019618010.3390/jcdd9060180Evaluation of the Appropriate Use of Coronary Computed Tomography Angiography: A Retrospective, Single-Center AnalysisKatharina Birkl0Christoph Beyer1Fabian Plank2Gudrun Maria Feuchtner3Guy Friedrich4Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, AustriaDepartment of Radiology, Innsbruck Medical University, 6020 Innsbruck, AustriaDepartment of Internal Medicine III–Cardiology and Angiology, Innsbruck Medical University, 6020 Innsbruck, AustriaDepartment of Radiology, Innsbruck Medical University, 6020 Innsbruck, AustriaDepartment of Internal Medicine III–Cardiology and Angiology, Innsbruck Medical University, 6020 Innsbruck, AustriaPurpose: We assessed the application of appropriate use criteria of coronary computed tomography angiography (CCTA) in comparison to invasive coronary angiography results and revascularization rates in patients with coronary artery disease (CAD). Methods: 1305 patients referred to invasive coronary angiography (ICA) after CCTA were evaluated retrospectively. The primary indication for CCTA was assessed according to the consensus for intermediate-risk (15–85% pre-test probability) into appropriate (A), inappropriate (I), and uncertain while referring to published guidelines. Patients’ risk factors, angina, and heart failure symptoms (Canadian Cardiovascular Society classification (CCSC), New York Heart Association (NYHA); clinical data; and ICA results were gathered. Results: Of 1305 patients referred to CCTA prior to ICA, 496 (38.0%) were appropriate, 766 (56.9%) inappropriate, and 43 (3.3%) uncertain. Of 766 patients with inappropriate CCTA referrals, 370 (48.3%) were classified as “inappropriately low” (<15% pre-test probability) and 396 (51.7%) as “inappropriately high” (>85%) in regard to the recommended CCTA utilization. Sub-analysis of the adherence to the appropriate use criteria did not differ between the source of the referring physicians (intramural tertiary, private practice primary care, or external secondary care hospitals). Obstructive CAD with subsequent revascularization rates (total of 39.2%) did not differ significantly between the appropriate (38.3%), inappropriate (41.0%), or uncertain (23.3%) groups (<i>p</i> = 0.068). Conclusion: The total coronary revascularization rate after CCTA was 39.2% and not different among low, intermediate, and pre-test probability groups. These findings support the role of CCTA as an excellent gatekeeper in patients with suspected obstructive CAD even beyond pre-test probability calculation models.https://www.mdpi.com/2308-3425/9/6/180coronary computed tomography angiographyappropriate usecoronary artery diseaseinvasive coronary angiographypercutaneous coronary intervention |
| spellingShingle | Katharina Birkl Christoph Beyer Fabian Plank Gudrun Maria Feuchtner Guy Friedrich Evaluation of the Appropriate Use of Coronary Computed Tomography Angiography: A Retrospective, Single-Center Analysis Journal of Cardiovascular Development and Disease coronary computed tomography angiography appropriate use coronary artery disease invasive coronary angiography percutaneous coronary intervention |
| title | Evaluation of the Appropriate Use of Coronary Computed Tomography Angiography: A Retrospective, Single-Center Analysis |
| title_full | Evaluation of the Appropriate Use of Coronary Computed Tomography Angiography: A Retrospective, Single-Center Analysis |
| title_fullStr | Evaluation of the Appropriate Use of Coronary Computed Tomography Angiography: A Retrospective, Single-Center Analysis |
| title_full_unstemmed | Evaluation of the Appropriate Use of Coronary Computed Tomography Angiography: A Retrospective, Single-Center Analysis |
| title_short | Evaluation of the Appropriate Use of Coronary Computed Tomography Angiography: A Retrospective, Single-Center Analysis |
| title_sort | evaluation of the appropriate use of coronary computed tomography angiography a retrospective single center analysis |
| topic | coronary computed tomography angiography appropriate use coronary artery disease invasive coronary angiography percutaneous coronary intervention |
| url | https://www.mdpi.com/2308-3425/9/6/180 |
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