Screening coronary artery disease with computed tomography angiogram should limit normal invasive coronary angiogram, regardless of pretest probability

Performing functional testing (FT) or a computed tomography angiogram (CCTA) before invasive coronary angiogram (ICA) is recommended for coronary artery disease (CAD). We aimed to evaluate, in a real life setting, the rate of strictly normal ICA following a positive noninvasive test result. We inclu...

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Bibliographic Details
Published in:The American heart journal 2020-05, Vol.223, p.113-119
Main Authors: Houssany-Pissot, Sonia, Rosencher, Julien, Allouch, Philippe, Bensouda, Christophe, Pillière, Remy, Cacoub, Léa, Caussin, Christophe, El-Hadad, Simon, Makowski, Serge, Beverelli, Fabrizio, Cacoub, Patrice
Format: Article
Language:English
Subjects:
Angina pectoris
Cardiac stress tests
Cardiology
Cardiovascular disease
Computed tomography
Coronary artery
Coronary artery disease
Coronary vessels
Functional testing
Heart diseases
Ischemia
Patients
Population
Probability
Risk factors
Software
Studies
Subgroups
Tomography
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Summary:Performing functional testing (FT) or a computed tomography angiogram (CCTA) before invasive coronary angiogram (ICA) is recommended for coronary artery disease (CAD). We aimed to evaluate, in a real life setting, the rate of strictly normal ICA following a positive noninvasive test result. We included all patients who underwent an ICA with a prior positive FT or CCTA. Patients were categorized in 5 subgroups, according to pretest probability (PTP) of having a CAD. Main results of ICA were defined as normal ICA, nonobstructive CAD (non-oCAD), and obstructive CAD (oCAD). For 4,952 patients who underwent ICA following either a positive FT (3276, 66.2%) or CCTA (1676, 33.8%) result, the PTP was (1) low ( 65%; n = 965, 19.5%). ICA showed no CAD (819 patients, 16.5%), non-oCAD (1,193 patients, 24.1%), or oCAD (2940 patients, 59.4%). Without considering the PTP values, CCTA compared to FT showed less frequently normal ICA (7% vs 16.5%), and more frequently CAD (non-oCAD 27.9% vs 22.2%; oCAD 65.1% vs 56.4%) (all P 
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2019.12.023