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

Louise Nissen, Simon Winther, Morten Schmidt, Niels Peter Rønnow Sand, Grazina Urbonaviciene, Marek Wojciech Zelechowski, Martin Kirk Christensen, Martin Busk, Jess Lambrechtsen, Axel Diederichsen, Frank-Peter Elpert, Erik Lerkevang Grove, Hans Erik Bøtker, Morten Bøttcher

Research output: Contribution to journalJournal articleResearchpeer-review

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.

Original languageEnglish
JournalEuropean Heart Journal Cardiovascular Imaging
Volume21
Issue number12
Pages (from-to)1353-1362
ISSN2047-2404
DOIs
Publication statusPublished - 1. Dec 2020

Keywords

  • artery disease
  • coronary
  • coronary angiography
  • coronary computed tomography a
  • epidemiology
  • myocardial revascularization
  • ngiography

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