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Use of cardiac imaging in chronic coronary syndromes: the EURECA Imaging registry
Danilo Neglia1,2, Riccardo Liga3,4, Alessia Gimelli1
1Cardiovascular and Imaging Departments, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy.
Insights
Clinical practice often deviates from European Society of Cardiology (ESC) Guidelines for chronic coronary syndromes (CCS) diagnostic testing. Adhering to guidelines improves diagnostic yield and reduces invasive procedures.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Practice Guidelines
Background:
- The EURECA registry evaluated imaging use and adherence to European Society of Cardiology (ESC) Guidelines for chronic coronary syndromes (CCS).
- Assessed guideline adoption based on patient presentation and pre-test probability of obstructive coronary artery disease (CAD).
Purpose of the Study:
- To assess the real-world adoption of ESC Guidelines for diagnostic testing in patients with CCS.
- To evaluate the impact of guideline adherence on diagnostic yield and patient outcomes.
Main Methods:
- Prospective, multicentre registry (EURECA) including 5156 patients from 24 countries.
- Evaluation of diagnostic test utilization (ECG, stress imaging, CTCA, ICA) against ESC GL recommendations.
- Comparison of outcomes between patients managed with and without guideline-adherent diagnostic strategies.
Main Results:
- Significant non-adherence to ESC Guidelines was observed in 44% of patients.
- Guideline-adherent care was associated with less frequent invasive coronary angiography (ICA) and more frequent stress imaging or CTCA.
- Adherence led to higher rates of obstructive CAD diagnosis, revascularization, improved quality of life, and fewer repeat tests.
Conclusions:
- Current clinical practice shows significant deviation from ESC Guidelines for diagnostic testing in CCS.
- Adopting ESC Guidelines enhances diagnostic accuracy, therapeutic utility, and patient outcomes while reducing invasive procedures.
Background:
The prospective, multicentre EURECA registry assessed the use of imaging and adoption of the European Society of Cardiology (ESC) Guidelines (GL) in patients with chronic coronary syndromes (CCS).
Methods:
Between May 2019 and March 2020, 5156 patients were recruited in 73 centres from 24 ESC member countries. The adoption of GL recommendations was evaluated according to clinical presentation and pre-test probability (PTP) of obstructive coronary artery disease (CAD).
Results:
The mean age of the population was 64 ± 11 years, 60% of patients were males, 42% had PTP >15%, 27% had previous CAD, and ejection fraction was <50% in 5%. Exercise ECG was performed in 32% of patients, stress imaging as the first choice in 40%, and computed tomography coronary angiography (CTCA) in 22%. Invasive coronary angiography (ICA) was the first or downstream test in 17% and 11%, respectively. Obstructive CAD was documented in 24% of patients, inducible ischaemia in 19%, and 13% of patients underwent revascularization. In 44% of patients, the overall diagnostic process did not adopt the GL. In these patients, referral to stress imaging (21% vs. 58%; P < 0.001) or CTCA (17% vs. 30%; P < 0.001) was less frequent, while exercise ECG (43% vs. 22%; P < 0.001) and ICA (48% vs. 15%; P < 0.001) were more frequently performed. The adoption of GL was associated with fewer ICA, higher proportion of diagnosis of obstructive CAD (60% vs. 39%, P < 0.001) and revascularization (54% vs. 37%, P < 0.001), higher quality of life, fewer additional testing, and longer times to late revascularization.
Conclusions:
In patients with CCS, current clinical practice does not adopt GL recommendations on the use of diagnostic tests in a significant proportion of patients. When the diagnostic approach adopts GL recommendations, invasive procedures are less frequently used and the diagnostic yield and therapeutic utility are superior.
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