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Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
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CT coronary angiography in low- to intermediate-risk patients: less radiation, less invasive angiography, and less

Kirsten Schou Nørgaard1, Christin Isaksen, Jørgen Selmer Buhl

  • 1Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital , Silkeborg , Denmark.

Scandinavian Cardiovascular Journal : SCJ
|May 29, 2014
PubMed

Insights

Reductions in invasive coronary angiography and coronary revascularisation following CT coronary angiography were not due to patient changes. Increased use of perfusion scans and functional coronary flow reserve measurements drove these changes, alongside reduced radiation doses.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Health Services Research

Background:

  • CT coronary angiography (CTCA) is increasingly used for diagnosing coronary artery disease (CAD).
  • Understanding trends in downstream invasive procedures after CTCA is crucial for optimizing patient care pathways.
  • Patient characteristics may influence referral patterns for invasive coronary angiography (ICA) and coronary revascularisation (CR).

Purpose of the Study:

  • To investigate if changes in patient characteristics explain the observed alterations in ICA and CR use after CTCA.
  • To evaluate the impact of evolving diagnostic strategies on invasive procedures in patients with low to intermediate pre-test probability of CAD.

Main Methods:

  • A cohort study utilizing data from the Western Denmark Heart Registry.
  • Analysis of 3541 patients undergoing CTCA between January 2010 and December 2013.
  • Follow-up data collection until March 2014.

Main Results:

  • Median radiation dose from CTCA significantly decreased (4.2 to 2.2 mSv).
  • Immediate referral rates for myocardial perfusion scans increased (2.8% to 10.0%), while rates for ICA decreased (25.3% to 10.8%).
  • Coronary revascularisation rates diminished (10.4% to 6.3%), with adjusted hazard ratios showing significant reductions in 2013 compared to 2010.

Conclusions:

  • Significant reductions in ICA and CR use post-CTCA were observed.
  • These reductions were not attributable to changes in patient demographics or clinical characteristics.
  • The shift is primarily driven by increased utilization of non-invasive functional testing, such as perfusion scans and coronary flow reserve measurements.
Abstract

Keywords:
angiographydiagnosisischaemic heart disease

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