Inpatient cardiac computed tomography angiography in Germany between 2005 and 2023: a nationwide registry study

Cardiac computed tomography angiography (CCTA) is a non-invasive imaging method, which enables detailed evaluation of the cardiac anatomy and the assessment of coronary artery disease (CAD). The diagnostic quality and availability improved, while data on the actual use of CCTA is sparse. We aimed to evaluate in-hospital CCTA utilization, the related diagnoses, and procedures in Germany in recent years.

Data from the Federal Statistical Office of Germany on all in-hospital CCTA cases between 2005 and 2023 was used. Clinical diagnoses, procedures, and in-hospital outcomes were analyzed. In subgroup analyses, we evaluated the use of CCTA among all cases with the primary diagnosis of CAD.

A total of 475,740 cases (median age 72 [60, 80] years, 43.8% females) underwent CCTA. The most common primary diagnoses of the in-hospital CCTA scans were aortic valve diseases (28.7%), atrial fibrillation and flutter (19.5%), and CAD (16.4%). The majority of CCTA scans was performed in urban hospitals (59.3%). Over time, the number of CCTA substantially increased (factor 11). Among all cases with the primary diagnosis CAD (n = 12,153,473), a minority of 78,199 (0.6%) underwent CCTA scans. Among CAD, younger patients and more females received a CCTA scan and in these cases less invasive coronary angiographies and interventions were performed.

CCTA is increasingly used in cardiovascular care. Inpatient CCTA scans were performed for the evaluation of aortic valve diseases, atrial fibrillation and flutter and CAD.