Stertman Erik, Gabro Fade, Sandstedt Mårten, Sysoev Oleg, Lauermann Jörg, Östgren Carl Johan, Lawesson Sofia Sederholm, Engvall Jan, Nilsson Staffan, Iredahl Fredrik
Primary Health Care Center, Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Universitetssjukhuset, Linköping, 581 83, Sweden.
Department of Radiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
BMC Prim Care. 2025 May 20;26(1):178. doi: 10.1186/s12875-025-02877-z.
Coronary Computed Tomography Angiography (CCTA) is recommended as a first-line investigation to exclude significant coronary artery stenosis in case of low to intermediate pre-test probability (PTP). The aim was to investigate CCTA findings in relation to the PTP of patients referred directly from primary health care centres.
METHODS/RESULTS: In this retrospective cohort study consecutive primary care CCTA referrals in a Swedish county 1st of June 2021 until 30th Nov. 2022 were included. CCTA reports were obtained for 483 patients ≥ 30 years old, without known CAD and stratified as no CAD, with atheromatosis or with suspected significant stenosis. For the 381 patients with eligible PTP data, the mean age was 60 years and 70% were women. While the median PTP was 11%, significant stenosis was suspected on CCTA in 18%. Among patients with PTP ≤ 15%, CCTA exposed no significant stenosis in 88%. No significant stenosis was found in patients with PTP < 5% true to patient age and gender in a sensitivity analysis (n = 25).
CCTA ruled out coronary stenosis as the cause of chest pain and dyspnea in 88% of patients referred from primary care with PTP 5-15%. PTP estimations by primary care physicians in CCTA referrals agreed with the occurrence of suspected significant stenosis among patients with PTP 5-15%, but underestimated it in PTP > 15%. The validity of PTP estimates < 5% was low.
对于预检概率为低到中度的情况，冠状动脉计算机断层扫描血管造影（CCTA）被推荐作为排除严重冠状动脉狭窄的一线检查方法。本研究旨在调查直接来自初级保健中心的患者的CCTA检查结果与预检概率之间的关系。
方法/结果：在这项回顾性队列研究中，纳入了瑞典一个县在2021年6月1日至2022年11月30日期间连续接受初级保健CCTA检查的患者。获取了483例年龄≥30岁、无已知冠心病的患者的CCTA报告，并将其分为无冠心病、有动脉粥样硬化或疑似严重狭窄。对于381例有合格预检概率数据的患者，平均年龄为60岁，70%为女性。虽然预检概率中位数为11%，但CCTA怀疑有18%的患者存在严重狭窄。在预检概率≤15%的患者中，88%的CCTA检查未发现严重狭窄。在敏感性分析中（n = 25），预检概率<5%的患者根据年龄和性别未发现严重狭窄。
在预检概率为5%-15%的初级保健转诊患者中，88%的患者CCTA排除了胸痛和呼吸困难的原因是冠状动脉狭窄。初级保健医生对CCTA转诊患者的预检概率估计与预检概率为5%-15%的患者中疑似严重狭窄的发生率相符，但在预检概率>15%的患者中低估了该发生率。预检概率估计<5%的有效性较低。
