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

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

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...

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Veröffentlicht in:European heart journal cardiovascular imaging 2020-12, Vol.21 (12), p.1353-1362
Hauptverfasser: 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
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container_issue 12
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container_title European heart journal cardiovascular imaging
container_volume 21
creator 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
description 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 
doi_str_mv 10.1093/ehjci/jeaa197
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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 &lt; 0.0001). Revascularization in patients referred to ICA after CCTA increased from 33.8% in 2008–10 vs. 44.4% in 2014–17 (P &lt; 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: &lt;50 years: 60% increase, 50–59 years: 33% increase, 60–69 years: 0%, and &gt;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.</description><identifier>ISSN: 2047-2404</identifier><identifier>EISSN: 2047-2412</identifier><identifier>DOI: 10.1093/ehjci/jeaa197</identifier><identifier>PMID: 32888290</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><ispartof>European heart journal cardiovascular imaging, 2020-12, Vol.21 (12), p.1353-1362</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com. 2020</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c295t-b95776f7e10022e6545d71bf4359674a5140ee1d37a59a6574c462b7100a31693</citedby><cites>FETCH-LOGICAL-c295t-b95776f7e10022e6545d71bf4359674a5140ee1d37a59a6574c462b7100a31693</cites><orcidid>0000-0001-5885-9537</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32888290$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nissen, Louise</creatorcontrib><creatorcontrib>Winther, Simon</creatorcontrib><creatorcontrib>Schmidt, Morten</creatorcontrib><creatorcontrib>Rønnow Sand, Niels Peter</creatorcontrib><creatorcontrib>Urbonaviciene, Grazina</creatorcontrib><creatorcontrib>Zelechowski, Marek Wojciech</creatorcontrib><creatorcontrib>Christensen, Martin Kirk</creatorcontrib><creatorcontrib>Busk, Martin</creatorcontrib><creatorcontrib>Lambrechtsen, Jess</creatorcontrib><creatorcontrib>Diederichsen, Axel</creatorcontrib><creatorcontrib>Elpert, Frank-Peter</creatorcontrib><creatorcontrib>Grove, Erik Lerkevang</creatorcontrib><creatorcontrib>Bøtker, Hans Erik</creatorcontrib><creatorcontrib>Bøttcher, Morten</creatorcontrib><title>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</title><title>European heart journal cardiovascular imaging</title><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><description>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 &lt; 0.0001). Revascularization in patients referred to ICA after CCTA increased from 33.8% in 2008–10 vs. 44.4% in 2014–17 (P &lt; 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: &lt;50 years: 60% increase, 50–59 years: 33% increase, 60–69 years: 0%, and &gt;70 years: 9.5% decrease. 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title 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
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