EACVI survey on investigations and imaging modalities in chronic coronary syndromes

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Chronic coronary syndromes require accurate assessment and management.
• Current practices in evaluating these conditions vary globally.
• The European Association of Cardiovascular Imaging (EACVI) initiated a survey to understand these practices.

Purpose of the Study:

• To evaluate the current global practices for assessing and managing patients with suspected and confirmed chronic coronary syndromes.
• To identify variations in the utilization of non-invasive imaging modalities.
• To assess the adherence to guideline recommendations in clinical decision-making.

Main Methods:

• A global survey was conducted among 110 imaging centers in 37 countries.
• Data collected included the availability of non-invasive investigations and their application in patient assessment.
• Respondents' approaches to initial assessment, recurrent chest pain, and asymptomatic disease management were recorded.

Main Results:

• Most non-invasive tests for coronary artery disease are widely available, with cardiovascular magnetic resonance being less common (40%).
• Coronary computed tomography angiography (CCTA) and nuclear scans are multidisciplinary team-reported in only 25% of centers.
• Only 32% of centers use pre-test probability for initial assessment, while 31% proceed directly to CCTA.
• For recurrent chest pain, stress echocardiography (27%) and nuclear scans (26%) are preferred.
• In asymptomatic patients with obstructive coronary artery disease, a significant proportion (58% for RCA stenosis) are managed medically without further testing, but this decreases with stenosis severity (1% for left main).
• For asymptomatic patients with moderate-to-severe ischemia, only 18% continue medical therapy without further investigation.

Conclusions:

• Guideline-recommended pre-test probability assessments are underutilized in suspected coronary artery disease diagnosis.
• A substantial minority of centers (one-third) directly utilize CCTA, bypassing initial probability assessments.
• Clinicians show reluctance in adopting optimal medical therapy as a standalone strategy for patients with controlled symptoms but significant coronary artery stenoses or myocardial ischemia.