Diagnostic Accuracy and Impact of Computed Tomographic Coronary Angiography on Utilization of Invasive Coronary Angiography

Abstract

Background-Computed tomographic coronary angiography (CTA), given its high negative predictive value, is a potential gatekeeper for invasive coronary angiography (ICA). Before CTA can be further accepted into clinical practice, its impact on healthcare resources needs to be better understood. We sought to determine the clinical impact of CTA on ICA referrals, CTA accuracy, and normalcy rate. Methods and Results-To determine the impact of CTA, consecutive patients (nϭ7017) undergoing ICA before and after implementing a dedicated cardiac CT program were reviewed and compared with 3 other centers (nϭ11 508). To determine CTA accuracy, we evaluated consecutive CTA patients who underwent ICA. For normalcy rate, we identified patients with a low pretest probability for obstructive coronary artery disease. . Because of referral bias, specificity (64% [CI, 44% to 81%]) was low; however, the normalcy rate of CTA was 94% (CI, 90% to 97%). After adjusting for referral bias, the adjusted sensitivity was 90% (CI, 89% to 91%), and the adjusted specificity was 95% (CI, 94% to 96%), with positive and negative predictive values of 92% (CI, 91% to 93%) and 93% (CI, 92% to 94%), respectively. Conclusion-The

One‐year Outcomes Following Coronary Computerized Tomographic Angiography for Evaluation of Emergency Department Patients with Potential Acute Coronary Syndrome

“…Coronary CTA has been associated with reduced utilization of coronary angiography and reduced revisit and readmission rates in other studies. 26,34,36 The rate of hospital readmission over the year following index presentation in our study appears lower than in other reports from our own institution prior to the introduction of coronary CTA. 37 …”

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

“…The yield of obstructive CAD based on downstream invasive angiography has recently been used as an outcome measure in studies designed to assess the clinical effectiveness of noninvasive cardiac diagnostic tests 8, 9, 10. Recent registry data suggest that only ≈38% of those referred for invasive angiography in the United States for the diagnosis of SCAD had obstructive CAD on invasive angiography 11, 12.…”

Computed Tomography Angiography Approach in Low-Intermediate Test Probability with Positive Exercise Electrocardiography Test in Young Women

“…This fi nding may be related to the functional evaluation advantages of MPS. Hence CCTA is an anatomical When appropriately used CCTA could help to minimize unnecessary invasive procedures (12) . However ionizing radiation and iodinated contrast, limits its use in clinical practice.…”