Noninvasive Cardiac Imaging Technologies in Detecting Coronary Artery Disease: From Research to Clinical Practice

Shan, Dongkai; Yang, Junjie; Chen, Yundai

doi:10.4103/cp.cp_3_20

Cited by 5 publications

(4 citation statements)

References 51 publications

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“…First, recent researches indicated that in terms of major clinical outcomes, CCTA-first strategy was superior or not inferior to NFT- or ICA-first strategy [ 7 , 9 , 49 , 53 , 54 ]. Second, CCTA are broadly available because of relatively low technical and personnel demands, while NFT, like positron emission tomography and stress cardiac magnetic resonance, although powerful, are much less available and their applicability is still limited by infrastructural and capacity requirements, especially in China [ 10 ]. Third, models constituting the ESC strategy were established in CCTA-based cohorts [ 3 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…In daily clinical routine, the evaluation of new-onset stable chest pain (SCP) suggestive of chronic coronary syndrome (CCS) remains a challenge for physicians, in consideration of the decreasing prevalence of coronary artery disease (CAD) and dramatically rising costs related to these patients [ 1 , 2 ]. Although coronary computed tomography angiography (CCTA) has been the first-line cardiac imaging testing (CIT) according to current recommendations [ 3 – 5 ], an increasing body of evidence pointed to the fact that most of patients referred to CCTA as well as other CIT had normal results and no adverse clinical events [ 6 – 10 ]. Thus, an optimal diagnostic strategy to identify low risk patients who may derive minimal benefit from further CIT is the cornerstone of clinical management for SCP, which has been proposed and reiterated by most recent guidelines to achieve potential financial savings and avoid exposing patients to unnecessary risk [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of two diagnostic strategies for patients with stable chest pain suggestive of chronic coronary syndrome: rationale and design of the double-blind, pragmatic, randomized and controlled OPERATE Trial

Zhou,

Xin,

Tan

et al. 2023

BMC Cardiovasc Disord

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Background To achieve potential financial savings and avoid exposing the patients to unnecessary risk, an optimal diagnostic strategy to identify low risk individual who may derive minimal benefit from further cardiac imaging testing (CIT) is important for patients with stable chest pain (SCP) suggestive of chronic coronary syndrome (CCS). Although several diagnostic strategies have been recommended by the most recent guidelines, few randomized controlled trials (RCTs) have prospectively investigated the actual effect of applying these strategies in clinical practice. Methods OPERATE (OPtimal Evaluation of stable chest pain to Reduce unnecessAry utilization of cardiac imaging TEsting) trial is an investigator-initiated, multicenter, coronary computed tomography angiography (CCTA)-based, 2-arm parallel-group, double-blind, pragmatic and confirmative RCT planning to include 800 subjects with SCP suggestive of CCS. After enrollment, all subjects will be randomized to two arms (2016 U.K. National Institute of Health and Care Excellence guideline-determined and 2019 European Society of Cardiology guideline-determined diagnostic strategy) on a 1:1 basis. According to each strategy, CCTA should be referred and deferred for a subject in high and low risk group, respectively. The primary (effectiveness) endpoint is CCTA without obstructive coronary artery disease. Safety of each strategy will be mainly assessed by 1-year major adverse cardiovascular event rates. Discussion The OPERATE trial will provide comparative effectiveness and safety evidences for two different diagnostic strategies for patients with SCP suggestive of CCS, with the intension of improving the diagnostic yield of CCTA at no expense of safety. Clinical trial registration ClinicalTrial.org Identifier NCT05640752.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of two diagnostic strategies for patients with stable chest pain suggestive of chronic coronary syndrome: rationale and design of the double-blind, pragmatic, randomized and controlled OPERATE Trial

Zhou,

Xin,

Tan

et al. 2023

BMC Cardiovasc Disord

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“…Previous studies have demonstrated that CCTA had a high negative predictive value compared with ICA [ 34 , 35 ]. Thus CCTA offered robust assurance to exclude obstructive CAD [ 36 ]. Fourth, our study did not include patients with dyspnea, and the conclusions should not be extrapolated to patients with known CAD, acute chest pain, no chest pain or classified into high-risk group according to 2021 GL [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Calcium Score Improves Risk Assessment of Symptomatic Patients in Low-Risk Group Based on Current Guidelines

Wang¹,

Zhang²,

Liu³

et al. 2023

Rev. Cardiovasc. Med.

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Background: The guidelines for evaluation and diagnosis of stable chest pain (SCP) released by American societies in 2021 (2021 GL) and European Society of Cardiology (ESC) in 2019 both recommended the estimation of pretest probability (PTP) by ESC-PTP model. Further risk assessment for the low-risk group according to 2021 GL (ESC-PTP 15%) is important but still remains unclear. Thus, the present study intended to comprehensively investigate the diagnostic and prognostic value of coronary artery calcium score (CACS) in these low-risk patients. Methods: From January 2017 to June 2019, we initially enrolled 8265 patients who were referred for CACS and coronary computed tomography angiography (CCTA) for the assessment of SCP. PTP of each patient was estimated by ESC-PTP model. Patients with ESC-PTP 15% were finally included and followed up for major adverse cardiovascular event (MACE) and utilization of invasive procedures until June 2022. The degree of coronary artery disease (CAD) on CCTA was defined as no CAD (0%), nonobstructive CAD (1–49%) and obstructive CAD ( 50%). Multivariate Cox proportional hazards and Logistic regression models were used to calculate adjusted hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs), respectively. Results: A total of 5183 patients with ESC-PTP 15% were identified and 1.6% experienced MACE during the 4-year follow-up. The prevalence of no CAD and obstructive CAD decreased and increased significantly ( p 0.0001) in patients with higher CACS, respectively, and 62% had nonobstructive CAD among those with CACS 0, resulting in dramatically increasing ORs for any stenosis 50% and 0% across CACS strata. Higher CACS was also associated with an elevated risk of MACE (adjusted HR of 3.59, 13.47 and 6.58 when comparing CACS = 0–100, CACS 100 and CACS 0 to CACS = 0, respectively) and intensive utilization of invasive procedures. Conclusions: In patients for whom subsequent testing should be deferred according to 2021 GL, high CACS conveyed a significant probability of substantial stenoses and clinical endpoints, respectively. These findings support the potential role of CACS as a further risk assessment tool to improve clinical management in these low-risk patients.

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“…Fourth, this analysis focused on the presence of coronary diameter stenosis ≥ 50%. Evaluation of high risk CAD, such as left main disease or 3-vessel disease with maximal degree of coronary diameter stenosis ≥ 70% would be helpful to identify patients who may derive maximal benefit from CR [ 38 – 40 ]. However, our data also supported the potential of CACS-CL strategy to optimize the downstream utilization of invasive procedures.…”

Section: Limitations Of the Studymentioning

confidence: 99%

Comparison of risk assessment strategies incorporating coronary artery calcium score with estimation of pretest probability to defer cardiovascular testing in patients with stable chest pain

Meng

Jiang

Ren

et al. 2023

BMC Cardiovasc Disord

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Background The risk assessment of patients with stable chest pain (SCP) to defer further cardiovascular testing is crucial, but the most appropriate risk assessment strategy remains unknown. We aimed to compare current strategies to identify low risk SCP patients. Methods 5289 symptomatic patients who had undergone coronary artery calcium score (CACS) and coronary computed tomographic angiography scan were identified and followed. Pretest probability (PTP) of obstructive coronary artery disease (CAD) for every patient was estimated according to European Society of Cardiology (ESC)-PTP model and CACS-weighted clinical likelihood (CACS-CL) model, respectively. Based on the 2019 ESC guideline-determined risk assessment strategy (ESC strategy) and CACS-CL model-based risk assessment strategy (CACS-CL strategy), all patients were divided into low and high risk group, respectively. Area under receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) was used. Results CACS-CL model provided more robust estimation of PTP than ESC-PTP model did, with a larger AUC (0.838 versus 0.735, p < 0.0001), positive IDI (9%, p < 0.0001) and less discrepancy between observed and predicted probabilities. As a result, compared to ESC strategy which only applied CACS-CL model to patients with borderline ESC-PTP, CACS-CL strategy incorporating CACS with estimation of PTP to entire SCP patients indicated a positive NRI (19%, p < 0.0001) and a stronger association to major adverse cardiovascular events, with hazard ratios: 3.97 (95% confidence intervals: 2.75–5.72) versus 5.11 (95% confidence intervals: 3.40–7.69). Conclusion The additional use of CACS for all SCP patients in CACS-CL strategy improved the risk assessment of SCP patients to identify individuals at low risk.

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Noninvasive Cardiac Imaging Technologies in Detecting Coronary Artery Disease: From Research to Clinical Practice

Cited by 5 publications

References 51 publications

Comparison of two diagnostic strategies for patients with stable chest pain suggestive of chronic coronary syndrome: rationale and design of the double-blind, pragmatic, randomized and controlled OPERATE Trial

Comparison of two diagnostic strategies for patients with stable chest pain suggestive of chronic coronary syndrome: rationale and design of the double-blind, pragmatic, randomized and controlled OPERATE Trial

Coronary Artery Calcium Score Improves Risk Assessment of Symptomatic Patients in Low-Risk Group Based on Current Guidelines

Comparison of risk assessment strategies incorporating coronary artery calcium score with estimation of pretest probability to defer cardiovascular testing in patients with stable chest pain

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