Birkl Katharina, Beyer Christoph, Plank Fabian, Feuchtner Gudrun Maria, Friedrich Guy
Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria.
Department of Internal Medicine III-Cardiology and Angiology, Innsbruck Medical University, 6020 Innsbruck, Austria.
J Cardiovasc Dev Dis. 2022 Jun 4;9(6):180. doi: 10.3390/jcdd9060180.
Purpose: We assessed the application of appropriate use criteria of coronary computed tomography angiography (CCTA) in comparison to invasive coronary angiography results and revascularization rates in patients with coronary artery disease (CAD). Methods: 1305 patients referred to invasive coronary angiography (ICA) after CCTA were evaluated retrospectively. The primary indication for CCTA was assessed according to the consensus for intermediate-risk (15−85% pre-test probability) into appropriate (A), inappropriate (I), and uncertain while referring to published guidelines. Patients’ risk factors, angina, and heart failure symptoms (Canadian Cardiovascular Society classification (CCSC), New York Heart Association (NYHA); clinical data; and ICA results were gathered. Results: Of 1305 patients referred to CCTA prior to ICA, 496 (38.0%) were appropriate, 766 (56.9%) inappropriate, and 43 (3.3%) uncertain. Of 766 patients with inappropriate CCTA referrals, 370 (48.3%) were classified as “inappropriately low” (<15% pre-test probability) and 396 (51.7%) as “inappropriately high” (>85%) in regard to the recommended CCTA utilization. Sub-analysis of the adherence to the appropriate use criteria did not differ between the source of the referring physicians (intramural tertiary, private practice primary care, or external secondary care hospitals). Obstructive CAD with subsequent revascularization rates (total of 39.2%) did not differ significantly between the appropriate (38.3%), inappropriate (41.0%), or uncertain (23.3%) groups (p = 0.068). Conclusion: The total coronary revascularization rate after CCTA was 39.2% and not different among low, intermediate, and pre-test probability groups. These findings support the role of CCTA as an excellent gatekeeper in patients with suspected obstructive CAD even beyond pre-test probability calculation models.
我们评估了冠状动脉计算机断层扫描血管造影（CCTA）的合理应用标准与冠状动脉疾病（CAD）患者的有创冠状动脉造影结果及血运重建率的对比情况。方法：对1305例在CCTA后接受有创冠状动脉造影（ICA）的患者进行回顾性评估。根据针对中度风险（检查前概率为15% - 85%）的共识，参照已发表的指南，将CCTA的主要指征评估为合适（A）、不合适（I）和不确定。收集患者的危险因素、心绞痛和心力衰竭症状（加拿大心血管学会分级（CCSC）、纽约心脏协会（NYHA））；临床数据以及ICA结果。结果：在1305例在ICA前接受CCTA检查的患者中，496例（38.0%）为合适，766例（56.9%）为不合适，43例（3.3%）为不确定。在766例CCTA转诊不合适的患者中，就推荐的CCTA应用而言，370例（48.3%）被归类为“不合适地低”（检查前概率<15%），396例（51.7%）被归类为“不合适地高”（>85%）。对合理应用标准的依从性亚分析在转诊医生来源（内部三级医疗机构、私人执业初级保健机构或外部二级医疗机构）之间没有差异。合适组（38.3%）、不合适组（41.0%）或不确定组（23.3%）之间，伴有后续血运重建率（总计39.2%）的阻塞性CAD没有显著差异（p = 0.068）。结论：CCTA后的总冠状动脉血运重建率为39.2%，在低、中及检查前概率组之间没有差异。这些发现支持了CCTA作为疑似阻塞性CAD患者的优秀筛选手段的作用，甚至超越了检查前概率计算模型。
