Use of cardiac imaging in chronic coronary syndromes: the EURECA Imaging registry

Abstract

Background The prospective, multicentre EURECA registry assessed the use of imaging and adoption of the European Society of Cardiology (ESC) Guidelines (GL) in patients with chronic coronary syndromes (CCS). Methods Between May 2019 and March 2020, 5156 patients were recruited in 73 centres from 24 ESC member countries. The adoption of GL recommendations was evaluated according to clinical presentation and pre-test probability (PTP) of obstructive coronary artery disease (CAD). Results The mean age of the population was 64 ± 11 years, 60% of patients were males, 42% had PTP >15%, 27% had previous CAD, and ejection fraction was <50% in 5%. Exercise ECG was performed in 32% of patients, stress imaging as the first choice in 40%, and computed tomography coronary angiography (CTCA) in 22%. Invasive coronary angiography (ICA) was the first or downstream test in 17% and 11%, respectively. Obstructive CAD was documented in 24% of patients, inducible ischaemia in 19%, and 13% of patients underwent revascularization. In 44% of patients, the overall diagnostic process did not adopt the GL. In these patients, referral to stress imaging (21% vs. 58%; P < 0.001) or CTCA (17% vs. 30%; P < 0.001) was less frequent, while exercise ECG (43% vs. 22%; P < 0.001) and ICA (48% vs. 15%; P < 0.001) were more frequently performed. The adoption of GL was associated with fewer ICA, higher proportion of diagnosis of obstructive CAD (60% vs. 39%, P < 0.001) and revascularization (54% vs. 37%, P < 0.001), higher quality of life, fewer additional testing, and longer times to late revascularization. Conclusions In patients with CCS, current clinical practice does not adopt GL recommendations on the use of diagnostic tests in a significant proportion of patients. When the diagnostic approach adopts GL recommendations, invasive procedures are less frequently used and the diagnostic yield and therapeutic utility are superior.

The Value of a Coronary Computed Tomography Angiography plus Stress Cardiac Magnetic Resonance Imaging Strategy for the Evaluation of Patients with Chronic Coronary Syndrome

“…Even in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, in which noninvasive testing was performed in 85% of the patients [ 19 ], only less than one-third of the patients had more than 10% ischemia on myocardial perfusion imaging [ 23 ]. Not surprisingly, in daily clinical practice, less than half of the patients undergo noninvasive stress testing before elective PCI [ 5 , 24 ]. In the FAME 2 trial [ 21 ], FFR-guided PCI with DES plus the best available medical therapy, as compared with the best available medical therapy alone, resulted in significantly improved clinical outcomes, driven by an increase by a factor of 8 in the need for urgent revascularization in the medical therapy alone group.…”

“…However, in patients with CCS, the current clinical practice does not adopt guidelines recommendations on the use of diagnostic tests in a significant proportion of patients. Importantly, when the diagnostic approach adopts guideline recommendations, invasive procedures are less frequently used, and the diagnostic yield and therapeutic utility are superior [ 5 ].…”

Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review

“…However, greater adoption of the guidelines might improve diagnostic decision-making in patients with suspected CCS. Based on the EURECA Imaging Registry, adoption of the 2019 European Society of Cardiology (ESC) guidelines resulted in less frequent ICA, as well as greater diagnosis of obstructive CAD (60% vs. 39%; p < 0.001) and revascularization (54% vs. 37%; p < 0.001) [59]. Furthermore, the 2019-ESC-pretest probability model was found to be accurate in predicting obstructive stenosis detected by a combined endpoint of CCTA and ICA [60].…”

The Role of Magnetic Resonance Imaging in Cardiomyopathies in the Light of New Guidelines: A Focus on Tissue Mapping

“…Imaging techniques have evolved over the years allowing a better understanding of these diseases [5,6]. For this reason a multimodal imaging approach, including ultrasound-based techniques, CMR imaging, computed tomography (CT), positron emission tomography (PET) and scintigraphy, is actually recommended in their diagnostic workup [2,[7][8][9].…”