Zhou Jia, Yang Jun-Jie, Yang Xia, Chen Zhi-Ye, He Bai, Du Luo-Shan, Chen Yun-Dai
Department of Cardiology, PLA General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2016 Jan 20;129(2):135-41. doi: 10.4103/0366-6999.173434.
Coronary computed tomographic angiography (CCTA) has been widely used in patients who are at intermediate risk for having stable coronary artery disease (SCAD), and 2013 European Society of Cardiology Guidelines on the Management of SCAD (2013G) recommended the appropriate application of CCTA. However, 2013G has not been subjected to systematic analyses for subsequent impact on clinical practice.
A total of 5320 patients suspected with SCAD were enrolled and scheduled for CCTA from March 2013 to September 2014. For each patient, pretest probability of SCAD was calculated according to updated Diamond-Forrester model (UDFM). Appropriate CCTA or appropriate stress test was determined as described in the 2013G. A generalized estimating equation model was used to determine the trends in the half-monthly rate of appropriate CCTA.
Overall, only 61.37% of patients received appropriate CCTA, and there was insignificant change over time (P = 0.8701). The application of CCTA in patients who should have had a stress test accounted for most of the inappropriate CCTA before (22.29%) or after (19.98%) the publication of the 2013G. In all patients or any subgroup, no significant change in the adjusted half-monthly rate of appropriate CCTA was found after the publication of the 2013G (odds ratio, 1.002; 95% confidence interval, 0.982-1.021; P = 0.8678).
These findings suggest that the 2013G have not, to date, been fully incorporated into clinical practice, and the clinical utilization of CCTA remains unreasonable to some extent.
冠状动脉计算机断层扫描血管造影（CCTA）已广泛应用于具有稳定冠状动脉疾病（SCAD）中度风险的患者，2013年欧洲心脏病学会关于SCAD管理的指南（2013G）推荐了CCTA的适当应用。然而，2013G尚未接受对后续临床实践影响的系统分析。
2013年3月至2014年9月，共纳入5320例疑似SCAD的患者并安排进行CCTA。对于每位患者，根据更新的Diamond-Forrester模型（UDFM）计算SCAD的预检概率。如2013G中所述确定适当的CCTA或适当的负荷试验。使用广义估计方程模型确定适当CCTA半月率的趋势。
总体而言，只有61.37%的患者接受了适当的CCTA，且随时间无显著变化（P = 0.8701）。在2013G发布之前（22.29%）或之后（19.98%），在应进行负荷试验的患者中应用CCTA占大多数不适当的CCTA。在所有患者或任何亚组中，2013G发布后适当CCTA的调整半月率均未发现显著变化（优势比，1.002；95%置信区间，0.982 - 1.021；P = 0.8678）。
这些发现表明，迄今为止，2013G尚未完全纳入临床实践，CCTA的临床应用在一定程度上仍然不合理。
