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Frontline diagnostic evaluation of patients suspected of angina by coronary computed tomography reduces downstream

Lene H Nielsen1, John Markenvard, Jesper M Jensen

  • 1Department of Cardiology, Lillebaelt Hospital-Vejle, Kabbeltoft 25, 7100, Vejle, Denmark.

The International Journal of Cardiovascular Imaging
|November 3, 2010
PubMed

Insights

Frontline exercise-stress testing (Ex-test) for angina leads to more downstream diagnostic procedures compared to coronary computed tomographic angiography (CTA). Further trials are needed to determine the most cost-effective diagnostic approach.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Health Services Research

Background:

  • Coronary computed tomographic angiography (CTA) use is increasing, raising concerns about unnecessary downstream procedures.
  • Previous studies have not evaluated the impact of frontline diagnostic testing strategies on subsequent test utilization in suspected angina patients.

Purpose of the Study:

  • To compare downstream test utilization following frontline exercise-stress testing (Ex-test) versus CTA in patients with suspected angina.

Main Methods:

  • Retrospective analysis of comparable cohorts (n=247 Ex-test, n=251 CTA) from Jan. 2007-Feb. 2008.
  • Recorded downstream test utilization (invasive coronary angiography, myocardial perfusion scintigraphy, CTA) within 12 months post-index test.

Main Results:

  • Overall downstream test utilization was significantly higher in the Ex-test group (32%) compared to the CTA group (21%) (P=0.003).
  • Myocardial perfusion scintigraphy was more frequent after Ex-test (9% vs. 4%, P=0.03).
  • Invasive coronary angiography showed a trend towards higher use after Ex-test (23% vs. 18%, P=0.15).

Conclusions:

  • Frontline Ex-test in symptomatic patients results in greater downstream diagnostic test utilization than frontline CTA.
  • Prospective trials are necessary to establish the most cost-effective diagnostic pathway using CTA versus conventional ischemia testing.

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