Cardiac computed tomographic angiography after abnormal ischemia test as a gatekeeper to invasive coronary angiography

This study aimed to determine the impact of systematic coronary computed tomographic angiography (CCTA) use following an abnormal non-invasive ischemia test (NIST) on patient selection strategy for invasive coronary angiography (ICA). In patients with suspected stable coronary artery disease (CAD),...

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Veröffentlicht in:The international journal of cardiovascular imaging 2022-04, Vol.38 (4), p.883-893
Hauptverfasser: Reis, João Ferreira, Ramos, Ruben Baptista, Marques, Hugo, Daniel, Pedro Modas, Aguiar, Sílvia Rosa, Morais, Luís Almeida, Cruz, Madalena Coutinho, Moreira, Rita Ilhão, Monteiro, André Viveiros, Cacela, Duarte, Figueiredo, Luísa, Ferreira, Rui Cruz
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Sprache:eng
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Zusammenfassung:This study aimed to determine the impact of systematic coronary computed tomographic angiography (CCTA) use following an abnormal non-invasive ischemia test (NIST) on patient selection strategy for invasive coronary angiography (ICA). In patients with suspected stable coronary artery disease (CAD), NIST use frequently results in sub-optimal diagnostic and revascularization yields of ICA. This randomized clinical trial, conducted at a single academic tertiary center, selected 220 symptomatic patients with mild-to-moderately abnormal NIST results who were referred for ICA. Patients received either the originally intended ICA (n = 105) or CCTA (n = 115). The primary endpoint was the diagnostic yield of ICA in each group. Revascularization yield and major adverse cardiovascular events at 12 months were also assessed. The patients were 69 ± 9 years old, 60% were men, and 31% had typical angina. Mean pre-test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 37.7% on the index angiographic procedure. In the CCTA group, ICA was cancelled by referring physicians in 83 patients (72.2%) after receiving CCTA results. For those undergoing ICA, diagnostic (84.4% vs. 41.7%, p
ISSN:1875-8312
1569-5794
1875-8312
1573-0743
DOI:10.1007/s10554-021-02426-6