Performing Computed Tomography Instead of Invasive Coronary Angiography

Bosserdt, Maria; Feger, Sarah; Rief, Matthias; Preuß, Daniel; Ibes, Paolo; Martus, Peter; Kofoed, Klaus F.; Laule, Michael; Perez, I. Vivas; Dewey, Marc

doi:10.1016/j.jcmg.2019.10.014

Cited by 3 publications

(3 citation statements)

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“…A possible explanation for this observation is that women may have a lower pretest probability of CAD than men and consequently a higher probability of suffering from chest pain due to other, noncardiac causes [ 25 ]. An earlier study suggests that women with atypical chest pain and a clinical indication for ICA benefit from a reduction of minor procedural complications when undergoing CTA instead of ICA [ 26 ]. Our study suggests that the detection of ECFs which may potentially explain atypical chest pain is another clinical benefit for women.…”

Section: Discussionmentioning

confidence: 99%

Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography

et al. 2021

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Objectives To compare the detection of relevant extracardiac findings (ECFs) on coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA) and evaluate the potential clinical benefit of their detection. Methods This is the prespecified subanalysis of ECFs in patients presenting with a clinical indication for ICA based on atypical angina and suspected coronary artery disease (CAD) included in the prospective single-center randomized controlled Coronary Artery Disease Management (CAD-Man) study. ECFs requiring immediate therapy and/or further workup including additional imaging were defined as clinically relevant. We evaluated the scope of ECFs in 329 patients and analyzed the potential clinical benefit of their detection. Results ECFs were detected in 107 of 329 patients (32.5%; CTA: 101/167, 60.5%; ICA: 6/162, 3.7%; p < .001). Fifty-nine patients had clinically relevant ECFs (17.9%; CTA: 55/167, 32.9%; ICA: 4/162, 2.5%; p < .001). In the CTA group, ECFs potentially explained atypical chest pain in 13 of 101 patients with ECFs (12.9%). After initiation of therapy, chest pain improved in 4 (4.0%) and resolved in 7 patients (6.9%). Follow-up imaging was recommended in 33 (10.0%; CTA: 30/167, 18.0%; ICA: 3/162, 1.9%) and additional clinic consultation in 26 patients (7.9%; CTA: 25/167, 15.0%; ICA: 1/162, 0.6%). Malignancy was newly diagnosed in one patient (0.3%; CTA: 1/167, 0.6%; ICA: 0). Conclusions In this randomized study, CTA but not ICA detected clinically relevant ECFs that may point to possible other causes of chest pain in patients without CAD. Thus, CTA might preclude the need for ICA in those patients. Trial registration NCT Unique ID: 00844220 Key Points • CTA detects ten times more clinically relevant ECFs than ICA. • Actionable clinically relevant ECFs affect patient management and therapy and may thus improve chest pain. • Detection of ECFs explaining chest pain on CTA might preclude the need for performing ICA.

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Section: Discussionmentioning

confidence: 99%

Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography

et al. 2021

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“…[12][13][14][15] Coronary computed tomography has been shown to be clinically useful for the non-invasive diagnosis of obstructive coronary artery disease in patients with stable chest pain and an intermediate pre-test probability because of a high diagnostic accuracy compared with invasive coronary angiography. [16][17][18][19] At the same time, computed tomography has been reported to have a comparable or slightly lower accuracy in women than in men, possibly owing to a reduced ability to detect stenosis in smaller coronary branches. 17 20 21 However, no large trials have assessed the gender specific comparative effectiveness of computed tomography and invasive coronary angiography as the initial test with regard to avoiding major procedure related complications and other key clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Coronary computed tomography has been shown to be clinically useful for the non-invasive diagnosis of obstructive coronary artery disease in patients with stable chest pain and an intermediate pre-test probability because of a high diagnostic accuracy compared with invasive coronary angiography 16171819. At the same time, computed tomography has been reported to have a comparable or slightly lower accuracy in women than in men, possibly owing to a reduced ability to detect stenosis in smaller coronary branches 172021.…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of initial computed tomography and invasive coronary angiography in women and men with stable chest pain and suspected coronary artery disease: multicentre randomised trial

2022

BMJ

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Objective To assess the comparative effectiveness of computed tomography and invasive coronary angiography in women and men with stable chest pain suspected to be caused by coronary artery disease. Design Prospective, multicentre, randomised pragmatic trial. Setting Hospitals at 26 sites in 16 European countries. Participants 2002 (56.2%) women and 1559 (43.8%) men (total of 3561 patients) with suspected coronary artery disease referred for invasive coronary angiography on the basis of stable chest pain and a pre-test probability of obstructive coronary artery disease of 10-60%. Intervention Both women and men were randomised 1:1 (with stratification by gender and centre) to a strategy of either computed tomography or invasive coronary angiography as the initial diagnostic test (1019 and 983 women, and 789 and 770 men, respectively), and an intention-to-treat analysis was performed. Randomised allocation could not be blinded, but outcomes were assessed by investigators blinded to randomisation group. Main outcome measures The primary endpoint was major adverse cardiovascular events (MACE; cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke). Key secondary endpoints were an expanded MACE composite (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, transient ischaemic attack, or major procedure related complication) and major procedure related complications. Results Follow-up at a median of 3.5 years was available in 98.9% (1979/2002) of women and in 99.0% (1544/1559) of men. No statistically significant gender interaction was found for MACE (P=0.29), the expanded MACE composite (P=0.45), or major procedure related complications (P=0.11). In both genders, the rate of MACE did not differ between the computed tomography and invasive coronary angiography groups. In men, the expanded MACE composite endpoint occurred less frequently in the computed tomography group than in the invasive coronary angiography group (22 (2.8%) v 41 (5.3%); hazard ratio 0.52, 95% confidence interval 0.31 to 0.87). In women, the risk of having a major procedure related complication was lower in the computed tomography group than in the invasive coronary angiography group (3 (0.3%) v 21 (2.1%); hazard ratio 0.14, 0.04 to 0.46). Conclusion This study found no evidence for a difference between women and men in the benefit of using computed tomography rather than invasive coronary angiography as the initial diagnostic test for the management of stable chest pain in patients with an intermediate pre-test probability of coronary artery disease. An initial computed tomography scan was associated with fewer major procedure related complications in women and a lower frequency of the expanded MACE composite in men. Trial registration NCT02400229ClinicalTrials.gov NCT02400229 .

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Effect of Body Mass Index on Effectiveness of CT versus Invasive Coronary Angiography in Stable Chest Pain: The DISCHARGE Trial

Sykes,

Collison,

Merkely

et al. 2024

Radiology

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Performing Computed Tomography Instead of Invasive Coronary Angiography

Cited by 3 publications

References 5 publications

Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography

Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography

Comparative effectiveness of initial computed tomography and invasive coronary angiography in women and men with stable chest pain and suspected coronary artery disease: multicentre randomised trial

Effect of Body Mass Index on Effectiveness of CT versus Invasive Coronary Angiography in Stable Chest Pain: The DISCHARGE Trial

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