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Reis JF, Ramos RB, Marques H, Daniel PM, Aguiar SR, Morais LA, Cruz MC, Moreira RI, Monteiro AV, Cacela D, Figueiredo L, Ferreira RC. Cardiac computed tomographic angiography after abnormal ischemia test as a gatekeeper to invasive coronary angiography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:883-893. [PMID: 35226221 DOI: 10.1007/s10554-021-02426-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/18/2021] [Indexed: 12/19/2022]
Abstract
This study aimed to determine the impact of systematic coronary computed tomographic angiography (CCTA) use following an abnormal non-invasive ischemia test (NIST) on patient selection strategy for invasive coronary angiography (ICA). In patients with suspected stable coronary artery disease (CAD), NIST use frequently results in sub-optimal diagnostic and revascularization yields of ICA. This randomized clinical trial, conducted at a single academic tertiary center, selected 220 symptomatic patients with mild-to-moderately abnormal NIST results who were referred for ICA. Patients received either the originally intended ICA (n = 105) or CCTA (n = 115). The primary endpoint was the diagnostic yield of ICA in each group. Revascularization yield and major adverse cardiovascular events at 12 months were also assessed. The patients were 69 ± 9 years old, 60% were men, and 31% had typical angina. Mean pre-test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 37.7% on the index angiographic procedure. In the CCTA group, ICA was cancelled by referring physicians in 83 patients (72.2%) after receiving CCTA results. For those undergoing ICA, diagnostic (84.4% vs. 41.7%, p<0.001) and revascularization (71.9% vs. 38.8%, p = 0.001) yields were significantly higher for CCTA-guided ICA than for standard NIST-guided ICA. Mean cumulative radiation exposure was significantly lower in the CCTA-guided ICA arm than in the NIST-guided ICA arm (12 ± 9 vs. 16 ± 10 mSv, respectively, p = 0.024). There were no significant differences in the primary safety endpoint rates between the strategies (p = 0.439). In patients with suspected CAD and mild-to-moderately abnormal ischemia tests, a diagnostic strategy including CCTA as a gatekeeper is safe and effective and significantly improves diagnostic and revascularization yields of ICA.
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Affiliation(s)
- João Ferreira Reis
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, nº 50, 1169-024, Lisbon, Portugal.
| | - Ruben Baptista Ramos
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, nº 50, 1169-024, Lisbon, Portugal
| | - Hugo Marques
- Department of Radiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Pedro Modas Daniel
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, nº 50, 1169-024, Lisbon, Portugal
| | - Sílvia Rosa Aguiar
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, nº 50, 1169-024, Lisbon, Portugal
| | - Luís Almeida Morais
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, nº 50, 1169-024, Lisbon, Portugal
| | - Madalena Coutinho Cruz
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, nº 50, 1169-024, Lisbon, Portugal
| | - Rita Ilhão Moreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, nº 50, 1169-024, Lisbon, Portugal
| | - André Viveiros Monteiro
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, nº 50, 1169-024, Lisbon, Portugal
| | - Duarte Cacela
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, nº 50, 1169-024, Lisbon, Portugal
| | - Luísa Figueiredo
- Department of Radiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, nº 50, 1169-024, Lisbon, Portugal
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