Practice Pattern, Diagnostic Yield, and Long-Term Prognostic Impact of Coronary Computed Tomographic Angiography

• Published in: Journal of the American Heart Association 2020-09, Vol.9 (18), p.e016620
• Main Authors: Cho, Min Soo, Roh, Jae-Hyung, Park, Hanbit, Cho, Sang-Cheol, Kang, Do-Yoon, Lee, Pil Hyung, Ahn, Jung-Min, Koo, Hyun Jung, Yang, Dong Hyun, Kang, Joon-Won, Park, Seung-Jung, Patel, Manesh R, Park, Duk-Woo
• Format: Article
• Language: English
• Subjects: Aged; cardiovascular outcomes; Coronary Angiography - statistics & numerical data; coronary artery bypass grafting; Coronary Artery Disease - diagnosis; Coronary Artery Disease - diagnostic imaging; coronary computed tomographic angiography; Coronary Vessels - diagnostic imaging; Female; Humans; Male; Middle Aged; Original Research; percutaneous coronary intervention; Practice Patterns, Physicians' - statistics & numerical data; Prognosis; Risk Factors
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.120.016620

Background Although guidelines recommend the use of coronary computed tomographic angiography (CTA) in patients with stable pain syndromes, the clinical benefits of the use of coronary CTA in a broad spectrum of patients is unknown. We evaluated the contemporary practice pattern and diagnostic yield of coronary CTA and their impact on the subsequent diagnostic-therapeutic cascade and clinical outcomes. Methods and Results We identified 39 906 patients without known coronary artery disease (CAD) who underwent coronary CTA between January 2007 and December 2013. The patients' demographic characteristics, risk factors, symptoms, results of coronary CTA, the appropriateness of downstream diagnostic and therapeutic interventions, and long-term outcomes (death or myocardial infarction) were evaluated. The number of coronary CTAs had increased over time, especially in asymptomatic patients. Coronary CTA revealed that 6108 patients (15.3%) had obstructive CAD (23.7% of symptomatic and 9.3% of asymptomatic patients). Subsequent cardiac catheterization was performed in 19.2% of symptomatic patients (appropriate, 80.6%) and in 3.9% of asymptomatic patients (appropriate, 7.9%). The 5-year rate of death or myocardial infarction was significantly higher in patients with obstructive CAD on CTA than those without (7.2% versus 3.0%;