Nationwide Trends of Gatekeeper to Invasive Coronary Angiography in Suspected Coronary Artery Disease

Abstract

Author's summary The trends of gatekeeping studies to invasive coronary angiography (ICA) requires further investigation. A total of 71,401 outpatients who underwent noninvasive cardiac tests or directly ICA for suspected coronary artery disease between 2012 and 2018 were included from the nationwide Korea Health Insurance Review and Assessment Service-National Patient Sample database. The proportion of coronary computed tomography angiography (CCTA) as a gatekeeper showed linear increase, while those of treadmill test (TMT), single-photon emission computed tomography (SPECT), and direct ICA have decreased. CCTA was associated with higher revascularization rate after ICA in pairwise comparison with TMT and SPECT (p<0.001).

Clinical Utility of Coronary Computed Tomography Angiography, Beyond the Gatekeeper for Invasive Coronary Angiography

“…2) However, accumulating data supports its utility for individuals at higher risk, and CCTA has been increasingly accepted as an effective imaging modality for primary testing in patients with suspected CAD. 3) In this issue of the Korean Circulation Journal , Cha et al 4) indicates the increasing use of CCTA as a gatekeeper for invasive coronary angiography, along with the decreasing use of the treadmill test, single photon emission computed tomography, and direct invasive coronary angiography. Increased use of CCTA is thought to be driven in part by its better prediction of obstructive CAD, increasingly strong outcome data, and similar or lower cost compared to that for functional imaging tests.…”