Prospective evaluation of the updated 2010 ACCF Cardiac CT Appropriate Use Criteria

• Published in: Journal of cardiovascular computed tomography 2012-03, Vol.6 (2), p.108-112
• Main Authors: Rich, Michael E., MD, Utsunomiya, Daisuke, MD, Simprini, Lauren A., MD, Weigold, Wm. Guy, MD, Weissman, Gaby, MD, Taylor, Allen J., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Appropriate Use Criteria; Cardiac CT; Cardiovascular; Chi-Square Distribution; Coronary Angiography - methods; Coronary Angiography - standards; Coronary Artery Disease - diagnostic imaging; District of Columbia; Female; Guideline Adherence; Humans; Male; Middle Aged; Patient Selection; Practice Guidelines as Topic; Practice Patterns, Physicians' - standards; Predictive Value of Tests; Prognosis; Prospective Studies; Referral and Consultation; Severity of Illness Index; Time Factors; Tomography, X-Ray Computed - standards; Unnecessary Procedures
• ISSN: 1934-5925; 1876-861X
• DOI: 10.1016/j.jcct.2012.02.003

Background The cardiac CT Appropriate Use Criteria (AUC) were updated in 2010 to reflect technical advances, evolving expert consensus, and rapidly expanding clinical evidence. Objective We evaluated the effect of the AUC update on their clinical performance, including the completeness and distribution of appropriateness ratings and test outcomes among a consecutive series of patients referred for CT angiography (CTA). Methods The 2006 and 2010 criteria were prospectively applied at the point of service to a consecutive series of patients referred for CTA at a single center (n = 1216). Patient interview and review of available health records were used to determine the CTA indication. The proportions of patients within categories of appropriate (A), uncertain (U), inappropriate (I), and not covered were described and compared between the 2006 and 2010 criteria. Results The 2010 criteria significantly reduced the proportion of uncertain (30.5%–11.4%), inappropriate (16.0%–12.9%), and no covered (12.1%–4.7%; P < 0.001) indications, while increasing the proportion of appropriate tests from 41.4% to 71%. By the 2010 criteria, appropriate indications were more likely to lead to the detection of coronary artery stenosis (11.5% vs 6.7%; P = 0.03) and complete examinations (95.0% vs 90.8%; P = 0.03). Conclusion The 2010 cardiac CT AUC update lead to more complete classification and to large shifts in the appropriateness ratings, underscoring the importance of ensuring the periodic revision of AUCs for evolving imaging technologies such that they perform optimally as quality measurement and reimbursement tools.