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Updated: Aug 5, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Protocol for optimizing the utilization rates of coronary angiography in Norway
Andreas Kristensen1,2, Marit Herder1,3, Erlend Aune4
1The Arctic University of Norway, Tromsø, Norway.
Insights
To reduce unnecessary invasive coronary angiography (CAG), this study recommends using coronary computed tomography angiography (CCTA) as a first-line test for suspected coronary artery disease, aiming for a 5-10% reduction in invasive procedures.
Area of Science:
- Cardiology
- Radiology
- Health Services Research
Background:
- Invasive coronary angiography (CAG) is frequently performed in Norway, with 37% of procedures in 2022 showing normal findings, suggesting potential overuse.
- Significant regional disparities exist in the utilization of CAG and coronary computed tomography angiography (CCTA).
Purpose of the Study:
- To identify strategies for reducing the utilization of CAG in patients with suspected coronary artery disease.
- To optimize diagnostic pathways for suspected coronary artery disease.
Main Methods:
- Retrospective analysis of registry data.
- Review of European Society of Cardiology (ESC) guidelines.
- Multidisciplinary task force evaluation.
Main Results:
- Complication rates for CAG in stable patients are low (0.6%).
- Coronary computed tomography angiography (CCTA) is recommended as a first-line imaging test for patients with low-to-moderate pre-test probability and suspected Chronic Coronary Syndrome (CCS).
Conclusions:
- Standardizing CCTA protocols and reports using CAD-RADS 2.0 is crucial.
- Mandatory CCTA registration in the Norwegian Registry of Invasive Cardiology (NORIC) and collaboration between radiologists and cardiologists are essential.
- The goal is to decrease invasive procedures without revascularization by 5-10% nationally.
Background:
Invasive coronary angiography (CAG) remains widely used in Norway, with 37% of procedures in 2022 yielding normal findings, indicating potential overuse.
Methods:
A national multidisciplinary task force performed a retrospective registry-based analysis and reviewed the European Society of Cardiology (ESC) guidelines to identify strategies aimed at reducing the utilization of CAG in patients with suspected coronary disease.
Results:
Significant regional variation in CAG and Coronary Computed Tomography Angiography (CCTA) utilization was observed. Complication rates for CAG in stable patients were low, 0.6%. In patients with low and moderate pre-test probability and suspected Chronic Coronary Syndrome (CCS), CCTA is recommended as a first-line imaging test.
Conclusion:
Standardization of CCTA protocols and reports, using CAD-RADS 2.0, mandatory CCTA registration in Norwegian Registry of Invasive Cardiology (NORIC), and formal collaboration between radiologists and cardiologists are essential initiatives. The aim is to reduce invasive procedures not resulting in revascularization by 5-10 percentage points nationally.
