Downstream testing after CT coronary angiography: time for a rethink?

Morgan-Hughes, Gareth, Williams, Michelle Claire, Loudon, Margaret, Roobottom, Carl A, Veitch, Alice, Van Lingen, Robin, Holloway, Ben, Bellenger, Nicholas, Schmitt, Matthias and Bull, Russel (2021) Downstream testing after CT coronary angiography: time for a rethink? Open heart, 8 (1). ISSN 2053-3624. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://openheart.bmj.com/content/8/1/e001597.long

Abstract

OBJECTIVE

We surveyed UK practice and compliance with the National Institute for Health and Care Excellence (NICE) 'recent-onset chest pain' guidance (Clinical Guideline 95, 2016) as a service quality initiative. We aimed to evaluate the diagnostic utility and efficacy of CT coronary angiography (CTCA), NICE-guided investigation compliance, invasive coronary angiography (ICA) use and revascularisation.

METHODS

A prospective analysis was conducted in nine UK centres between January 2018 and March 2020. The reporter decided whether the CTCA was diagnostic. Coronary artery disease was recorded with the Coronary Artery Disease-Reporting and Data System (CAD-RADS). Local electronic records and picture archiving/communication systems were used to collect data regarding functional testing, ICA and revascularisation. Duplication of coronary angiography without revascularisation was taken as a surrogate for ICA overuse.

RESULTS

5293 patients (mean age, 57±12 years; body mass index, 29±6 kg/m²; 50% men) underwent CTCA, with a 96% diagnostic scan rate. 618 (12%) underwent ICA, of which 48% (298/618) did not receive revascularisation. 3886 (73%) had CAD-RADS 0-2, with 1% (35/3886) undergoing ICA, of which 94% (33/35) received ICA as a second-line test. 547 (10%) had CAD-RADS 3, with 23% (125/547) undergoing ICA, of which 88% (110/125) chose ICA as a second-line test, with 26% (33/125) leading to revascularisation. For 552 (10%) CAD-RADS 4 and 91 (2%) CAD-RADS 5 patients, ICA revascularisation rates were 64% (221/345) and 74% (46/62), respectively.

CONCLUSIONS

While CTCA for recent-onset chest pain assessment has been shown to be a robust test, which negates the need for further investigation in three-quarters of patients, subsequent ICA overuse remains with almost half of these procedures not leading to revascularisation.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
WN Medical imaging. Radiology
Divisions: Clinical Support > Radiology
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 04 Mar 2021 13:39
Last Modified: 04 Mar 2021 13:39
URI: http://www.repository.uhblibrary.co.uk/id/eprint/4053

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