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Published on: August 28, 2018
Triage of patients with suspected coronary artery disease using multislice computed tomography
Hans Hoffmann1, Hans-Peter Dübel, Horst Laube
1Department of Radiology, Charité, Humboldt University Medical School, Berlin, Germany.
Insights
Multislice computed tomography (MSCT) reliably triages patients with suspected coronary artery disease (CAD) for revascularization. Decisions based on MSCT showed high agreement with conventional coronary angiography, unlike those between different specialists.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Multislice computed tomography (MSCT) demonstrates high accuracy in detecting coronary artery stenoses.
- Current diagnostic pathways for suspected coronary artery disease (CAD) involve invasive procedures.
Purpose of the Study:
- To evaluate the reliability of MSCT in guiding therapeutic decisions for CAD patients.
- To compare MSCT-guided decisions with conventional coronary angiography (CATH) and expert opinions.
Main Methods:
- 123 patients with suspected CAD underwent both MSCT and CATH.
- Therapeutic decisions based on MSCT and CATH were compared against current CAD treatment guidelines.
- Decisions were also compared between an interventional cardiologist and a cardiac surgeon.
Main Results:
- MSCT-guided decisions showed 88% agreement with CATH-based guideline decisions (82/94 patients).
- Significant discrepancies were observed between cardiologist and surgeon treatment recommendations based on CATH (79% agreement).
- 100% agreement was found for decisions regarding invasive treatment versus no intervention.
Conclusions:
- MSCT is a reliable tool for triaging patients with suspected CAD for coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or no revascularization.
- The choice of revascularization strategy is more influenced by the consulting specialist than by the diagnostic imaging modality used.
Rationale And Objectives:
Several studies have shown that multislice computed tomography (MSCT) has a high sensitivity and specificity for detecting coronary artery stenoses. The aim of the present study was to investigate whether MSCT can reliably triage patients with suspected coronary artery disease (CAD) to coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or no revascularization.
Materials And Methods:
A total of 123 patients with suspected CAD who were referred for conventional coronary angiography (CATH) additionally underwent MSCT (16*0.5 mm detector collimation). Therapeutic decisions made on the basis of CATH and MSCT strictly following current guidelines for treatment of CAD were compared with decisions made by a cardiac surgeon and an interventional cardiologist. Only MSCTs with at least adequate image quality in all coronary segments were included in the analysis (94/123).
Results:
Decisions made on the basis of MSCT and CATH according to guidelines did not differ significantly (agreement of 88%, 82 of 94, P = .319). The therapeutic decisions made by the interventional cardiologist and the cardiac surgeon based on CATH differed significantly (overall agreement of 79%, 74 of 94 cases, P < .001; cardiologist: 78% PCI and 22% CABG versus surgeon: 38% PCI and 62% CABG), whereas there was 100% agreement regarding decisions for or against invasive treatment.
Conclusions:
MSCT shows good agreement with CATH in triaging patients with suspected CAD to CABG, PCI, or no revascularization. The choice of revascularization procedure is significantly more strongly influenced by whether an interventional cardiologist or a cardiac surgeon makes the decision than by the diagnostic test on which the decision is based.
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