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Temporal trends in referral patterns for invasive coronary angiography – a multicenter 10-year analysis
Session:
Sessão de Comunicações Orais - Doença Coronária
Speaker:
Mariana Gonçalves
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Gonçalves; David Cabrita Roque; Pedro de Araújo Gonçalves; Miguel Borges Santos; Rui Campante Teles; Sérgio Bravo Baptista; Catarina Brízido; Mariana Faustino; Pedro Farto e Abreu; Manuel Almeida; António Ferreira
Abstract
<p><strong>Background</strong>: The evaluation of patients with suspected stable coronary artery disease (CAD) is based on clinical assessment and noninvasive testing serving as “gatekeeper” for invasive coronary angiography (ICA). The purpose of this study was to assess the temporal trends in the usage pattern of non-invasive testing before ICA and its diagnostic yield in patients with suspected CAD.</p> <p><strong>Methods</strong>: Cross-sectional observational multicenter study of 4805 consecutive patients (60% male, mean age 66±10 years) without known CAD, undergoing elective ICA due to stable chest pain symptoms in two centers between January 2008 and December 2017. The use of noninvasive testing and the proportion of patients with obstructive CAD (defined as the presence of at least one ≥50% stenosis on ICA) were assessed.</p> <p><strong>Results</strong>: From an initial cohort of 11,102 patients undergoing ICA, 4805 patients were identified with initial suspicion of stable angina. Overall, 4038 (84%) had a positive noninvasive test: SPECT (38%, n=1828), exercise ECG (36%, n=1731), coronary CT angiography (6%, n=302), stress echocardiogram (3%, n=157), or stress cardiac magnetic resonance (0.4%, n=20). Obstructive CAD was found in 53% (n=2543) of the patients, with 46% (n=2209) having at least one stenosis >70%. Only 38% (n=1997) underwent revascularization either by percutaneous coronary intervention or surgery. Overall, only 12% of the patients with obstructive CAD underwent invasive functional assessment. This proportion did not increase significantly over the years (p for trend 0.405).</p> <p>The prevalence of obstructive CAD was higher in patients with vs. without previous noninvasive testing (54% vs. 46%, respectively, p<0.001) and tended to decrease during the study period (p for trend <0.001).</p> <p>Over this 10-year period, there were small but statistically significant decreases in the proportion of patients referred after exercise testing and SPECT (p for trend 0.005 and 0.006, respectively), and increases in referral after coronary CT angiography and stress CMR (both p for trend <0.001). The proportion of patients referred without previous testing remained stable (p for trend 0.251).</p> <p><strong>Conclusions</strong>: Half of the patients undergoing ICA for suspected CAD did not present obstructive coronary lesion. This proportion tended to increase over the 10-year span of this study. Better clinical assessment tools and diagnostic pathways for stable CAD seem to be needed. </p>
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