A team of international researchers found using coronary CT angiography (CCTA) to determine which patients with suspected coronary artery disease (CAD) would benefit from invasive angiography can reduce costly invasive procedures while achieving similar accuracy.
The study, published Dec. 12 in JACC: Cardiovascular Imaging, included more than 1,600 patients from 22 hospitals and cardiology practices from across the world who were referred for non-emergent invasive coronary angiography (ICA). Nearly half of patients were randomized for selective referral, and the remaining half for direct referral (immediate ICA). Those in the selective group first received CCTA and a clinician then decided if invasive angiography was necessary.
After a median follow-up of 12 months, each strategy achieved the same rate (4.6 percent) of major adverse cardiovascular events (MACE). This primary endpoint included death, MI, unstable angina, stroke, urgent revascularization or cardiac hospitalization.
In terms of follow-up testing, 23 percent of patients in the selective referral group underwent follow-up ICA—77 percent avoided doing so—and 100 percent of direct referral patients received ICA. Despite a higher proportion of patients in the selective referral group undergoing downstream electrocardiography, the selective group, which avoided ICA, reduced diagnostic evaluation costs by 57 percent, the authors wrote.
For patients in the selective referral group, the total diagnostic test cost averaged $1,183, compared to $2,755 for those who underwent immediate ICA.
“Growing evidence supports that noninvasive anatomic testing by CCTA alone, as a gatekeeper procedure, may prove advantageous in promptly and accurately identifying candidates for downstream procedures,” the authors concluded. “These data and similarly relevant findings from other randomized trials call for revisions to the current ischemic heart disease guidelines for the evaluation of patients with stable ischemic heart disease.”