Downstream testing after CT coronary angiography: time for a rethink?
Date
2021-02-23Author
Subject
Metadata
Show full item recordAbstract
<jats:sec><jats:title>Objective</jats:title><jats:p>We surveyed UK practice and compliance with the National Institute for Health and Care Excellence (NICE) ‘recent-onset chest pain’ guidance (Clinical Guideline 95, 2016) as a service quality initiative. We aimed to evaluate the diagnostic utility and efficacy of CT coronary angiography (CTCA), NICE-guided investigation compliance, invasive coronary angiography (ICA) use and revascularisation.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A prospective analysis was conducted in nine UK centres between January 2018 and March 2020. The reporter decided whether the CTCA was diagnostic. Coronary artery disease was recorded with the Coronary Artery Disease–Reporting and Data System (CAD-RADS). Local electronic records and picture archiving/communication systems were used to collect data regarding functional testing, ICA and revascularisation. Duplication of coronary angiography without revascularisation was taken as a surrogate for ICA overuse.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>5293 patients (mean age, 57±12 years; body mass index, 29±6 kg/m²; 50% men) underwent CTCA, with a 96% diagnostic scan rate. 618 (12%) underwent ICA, of which 48% (298/618) did not receive revascularisation. 3886 (73%) had CAD-RADS 0–2, with 1% (35/3886) undergoing ICA, of which 94% (33/35) received ICA as a second-line test. 547 (10%) had CAD-RADS 3, with 23% (125/547) undergoing ICA, of which 88% (110/125) chose ICA as a second-line test, with 26% (33/125) leading to revascularisation. For 552 (10%) CAD-RADS 4 and 91 (2%) CAD-RADS 5 patients, ICA revascularisation rates were 64% (221/345) and 74% (46/62), respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>While CTCA for recent-onset chest pain assessment has been shown to be a robust test, which negates the need for further investigation in three-quarters of patients, subsequent ICA overuse remains with almost half of these procedures not leading to revascularisation.</jats:p></jats:sec>
Collections
Publisher
Place of Publication
Journal
Volume
Issue
Pagination
Author URL
Number
Recommended, similar items
The following license files are associated with this item:
Related items
Showing items related by title, author, creator and subject.
-
Early computed tomography coronary angiography in adults presenting with suspected acute coronary syndrome: the RAPID-CTCA RCT
Gray, AJ; Roobottom, C; Smith, JE; Goodacre, S; Oatey, K; O’Brien, R; Storey, RF; Curzen, N; Keating, L; Kardos, A; Felmeden, D; Lee, RJ; Thokala, P; Lewis, SC; Newby, DE (National Institute for Health and Care Research (NIHR)England, 2022-09)Background Acute coronary syndrome is a common medical emergency. The optimal strategy to investigate patients who are at intermediate risk of acute coronary syndrome has not been fully determined. Objective To investigate ... -
Early computed tomography coronary angiography in patients with suspected acute coronary syndrome: randomised controlled trial
Gray, AJ; Roobottom, C; Smith, JE; Goodacre, S; Oatey, K; O’Brien, R; Storey, RF; Curzen, N; Keating, L; Kardos, A; Felmeden, D; Lee, RJ; Thokala, P; Lewis, SC; Newby, DE (BMJEngland, 2021-09-29)<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objectives</jats:title> <jats:p>To establish if the use of early computed tomography (CT) coronary angiography improves one year ... -
Non-invasive coronary CT angiography-derived fractional flow reserve: A benchmark study comparing the diagnostic performance of four different computational methodologies
Carson, JM; Pant, S; Roobottom, C; Alcock, R; Javier Blanco, P; Alberto Bulant, C; Vassilevski, Y; Simakov, S; Gamilov, T; Pryamonosov, R; Liang, F; Ge, X; Liu, Y; Nithiarasu, P (WileyEngland, 2019-10)Non-invasive coronary computed tomography (CT) angiography-derived fractional flow reserve (cFFR) is an emergent approach to determine the functional relevance of obstructive coronary lesions. Its feasibility and diagnostic ...