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 |
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| creator | 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 |
| description | 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%,
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| doi_str_mv | 10.1007/s10554-021-02426-6 |
| format | Article |
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p
<0.001) and revascularization (71.9% vs. 38.8%,
p
= 0.001) yields were significantly higher for CCTA-guided ICA than for standard NIST-guided ICA. Mean cumulative radiation exposure was significantly lower in the CCTA-guided ICA arm than in the NIST-guided ICA arm (12 ± 9 vs. 16 ± 10 mSv, respectively,
p
= 0.024). There were no significant differences in the primary safety endpoint rates between the strategies (
p
= 0.439). In patients with suspected CAD and mild-to-moderately abnormal ischemia tests, a diagnostic strategy including CCTA as a gatekeeper is safe and effective and significantly improves diagnostic and revascularization yields of ICA.</description><identifier>ISSN: 1875-8312</identifier><identifier>ISSN: 1569-5794</identifier><identifier>EISSN: 1875-8312</identifier><identifier>EISSN: 1573-0743</identifier><identifier>DOI: 10.1007/s10554-021-02426-6</identifier><identifier>PMID: 35226221</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Angina ; Angiography ; Cardiac Imaging ; Cardiology ; Cardiovascular disease ; Computed tomography ; Coronary artery ; Coronary artery disease ; Diagnostic systems ; Heart diseases ; Imaging ; Ischemia ; Medical imaging ; Medicine ; Medicine & Public Health ; Original Paper ; Patients ; Physicians ; Radiation ; Radiation effects ; Radiology</subject><ispartof>The international journal of cardiovascular imaging, 2022-04, Vol.38 (4), p.883-893</ispartof><rights>The Author(s), under exclusive licence to Springer Nature B.V. 2022</rights><rights>2022. The Author(s), under exclusive licence to Springer Nature B.V.</rights><rights>The Author(s), under exclusive licence to Springer Nature B.V. 2022.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-478a3285ad91b6e5a08d71e4fca7e69b4f0233ccd47028a376d8c1d51a99c34e3</citedby><cites>FETCH-LOGICAL-c419t-478a3285ad91b6e5a08d71e4fca7e69b4f0233ccd47028a376d8c1d51a99c34e3</cites><orcidid>0000-0003-0047-8306</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10554-021-02426-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10554-021-02426-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35226221$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reis, João Ferreira</creatorcontrib><creatorcontrib>Ramos, Ruben Baptista</creatorcontrib><creatorcontrib>Marques, Hugo</creatorcontrib><creatorcontrib>Daniel, Pedro Modas</creatorcontrib><creatorcontrib>Aguiar, Sílvia Rosa</creatorcontrib><creatorcontrib>Morais, Luís Almeida</creatorcontrib><creatorcontrib>Cruz, Madalena Coutinho</creatorcontrib><creatorcontrib>Moreira, Rita Ilhão</creatorcontrib><creatorcontrib>Monteiro, André Viveiros</creatorcontrib><creatorcontrib>Cacela, Duarte</creatorcontrib><creatorcontrib>Figueiredo, Luísa</creatorcontrib><creatorcontrib>Ferreira, Rui Cruz</creatorcontrib><title>Cardiac computed tomographic angiography after abnormal ischemia test as a gatekeeper to invasive coronary angiography</title><title>The international journal of cardiovascular imaging</title><addtitle>Int J Cardiovasc Imaging</addtitle><addtitle>Int J Cardiovasc Imaging</addtitle><description>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
<0.001) and revascularization (71.9% vs. 38.8%,
p
= 0.001) yields were significantly higher for CCTA-guided ICA than for standard NIST-guided ICA. Mean cumulative radiation exposure was significantly lower in the CCTA-guided ICA arm than in the NIST-guided ICA arm (12 ± 9 vs. 16 ± 10 mSv, respectively,
p
= 0.024). There were no significant differences in the primary safety endpoint rates between the strategies (
p
= 0.439). In patients with suspected CAD and mild-to-moderately abnormal ischemia tests, a diagnostic strategy including CCTA as a gatekeeper is safe and effective and significantly improves diagnostic and revascularization yields of ICA.</description><subject>Angina</subject><subject>Angiography</subject><subject>Cardiac Imaging</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Computed tomography</subject><subject>Coronary artery</subject><subject>Coronary artery disease</subject><subject>Diagnostic systems</subject><subject>Heart diseases</subject><subject>Imaging</subject><subject>Ischemia</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Paper</subject><subject>Patients</subject><subject>Physicians</subject><subject>Radiation</subject><subject>Radiation effects</subject><subject>Radiology</subject><issn>1875-8312</issn><issn>1569-5794</issn><issn>1875-8312</issn><issn>1573-0743</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kclOwzAQhi0EYim8AAdkiQuXgNcsR1SxSUhc4GxNnUlJaeJgJ5X69riEpeLAwbItf_5m7J-QU84uOWPZVeBMa5UwweNQIk3SHXLI80wnueRid2t9QI5CWDDGM1kU--RAaiFSIfghWU3BlzVYal3TDT2WtHeNm3voXmtLoZ3X42ZNoerRU5i1zjewpHWwr9jUQHsMPYVAgc6hxzfELmK9o3W7glCvMJq9a8Gvt23HZK-CZcCTr3lCXm5vnqf3yePT3cP0-jGxihd9orIcpMg1lAWfpaiB5WXGUVUWMkyLmaqYkNLaUmVMRDRLy9zyUnMoCisVygm5GL2dd-9D7NQ0sXFcLqFFNwQjUqm00pKlET3_gy7c4NvYXaQiEX8uFpsQMVLWuxA8VqbzdRNfZzgzm1TMmIqJqZjPVMxGffalHmYNlj9XvmOIgByBEI_aOfrf2v9oPwAK45k6</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Reis, João Ferreira</creator><creator>Ramos, Ruben Baptista</creator><creator>Marques, Hugo</creator><creator>Daniel, Pedro Modas</creator><creator>Aguiar, Sílvia Rosa</creator><creator>Morais, Luís Almeida</creator><creator>Cruz, Madalena Coutinho</creator><creator>Moreira, Rita Ilhão</creator><creator>Monteiro, André Viveiros</creator><creator>Cacela, Duarte</creator><creator>Figueiredo, Luísa</creator><creator>Ferreira, Rui Cruz</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0047-8306</orcidid></search><sort><creationdate>20220401</creationdate><title>Cardiac computed tomographic angiography after abnormal ischemia test as a gatekeeper to invasive coronary angiography</title><author>Reis, João Ferreira ; 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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
<0.001) and revascularization (71.9% vs. 38.8%,
p
= 0.001) yields were significantly higher for CCTA-guided ICA than for standard NIST-guided ICA. Mean cumulative radiation exposure was significantly lower in the CCTA-guided ICA arm than in the NIST-guided ICA arm (12 ± 9 vs. 16 ± 10 mSv, respectively,
p
= 0.024). There were no significant differences in the primary safety endpoint rates between the strategies (
p
= 0.439). In patients with suspected CAD and mild-to-moderately abnormal ischemia tests, a diagnostic strategy including CCTA as a gatekeeper is safe and effective and significantly improves diagnostic and revascularization yields of ICA.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>35226221</pmid><doi>10.1007/s10554-021-02426-6</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-0047-8306</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Angina Angiography Cardiac Imaging Cardiology Cardiovascular disease Computed tomography Coronary artery Coronary artery disease Diagnostic systems Heart diseases Imaging Ischemia Medical imaging Medicine Medicine & Public Health Original Paper Patients Physicians Radiation Radiation effects Radiology |
| title | Cardiac computed tomographic angiography after abnormal ischemia test as a gatekeeper to invasive coronary angiography |
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