Practice Pattern, Diagnostic Yield, and Long-Term Prognostic Impact of Coronary Computed Tomographic Angiography.

Journal Article (Journal Article)

Background Although guidelines recommend the use of coronary computed tomographic angiography (CTA) in patients with stable pain syndromes, the clinical benefits of the use of coronary CTA in a broad spectrum of patients is unknown. We evaluated the contemporary practice pattern and diagnostic yield of coronary CTA and their impact on the subsequent diagnostic-therapeutic cascade and clinical outcomes. Methods and Results We identified 39 906 patients without known coronary artery disease (CAD) who underwent coronary CTA between January 2007 and December 2013. The patients' demographic characteristics, risk factors, symptoms, results of coronary CTA, the appropriateness of downstream diagnostic and therapeutic interventions, and long-term outcomes (death or myocardial infarction) were evaluated. The number of coronary CTAs had increased over time, especially in asymptomatic patients. Coronary CTA revealed that 6108 patients (15.3%) had obstructive CAD (23.7% of symptomatic and 9.3% of asymptomatic patients). Subsequent cardiac catheterization was performed in 19.2% of symptomatic patients (appropriate, 80.6%) and in 3.9% of asymptomatic patients (appropriate, 7.9%). The 5-year rate of death or myocardial infarction was significantly higher in patients with obstructive CAD on CTA than those without (7.2% versus 3.0%; P<0.001; adjusted hazard ratio [95% CI], 1.34 [1.17-1.54]). However, obstructive CAD on CTA had limited added value over conventional risk factors for predicting death or myocardial infarction. Conclusions Although the use of coronary CTA had substantially increased, CTA had a low diagnostic yield for obstructive CAD, especially in asymptomatic patients. The use of CTA in asymptomatic patients seemed to have led to inappropriate subsequent diagnostic or therapeutic interventions without clinical benefit.

Full Text

Duke Authors

Cited Authors

  • Cho, MS; Roh, J-H; Park, H; Cho, S-C; Kang, D-Y; Lee, PH; Ahn, J-M; Koo, HJ; Yang, DH; Kang, J-W; Park, S-J; Patel, MR; Park, D-W

Published Date

  • September 15, 2020

Published In

Volume / Issue

  • 9 / 18

Start / End Page

  • e016620 -

PubMed ID

  • 32896194

Pubmed Central ID

  • PMC7726974

Electronic International Standard Serial Number (EISSN)

  • 2047-9980

Digital Object Identifier (DOI)

  • 10.1161/JAHA.120.016620

Language

  • eng

Conference Location

  • England