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Quality and safety of coronary computed tomography angiography at academic and non-academic sites: insights from a large European registry (ESCR MR/CT Registry)

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Abstract

Objectives

To compare the use of coronary computed tomography angiography (CCTA) between academic and non-academic sites across Europe over the last decade.

Methods

We analyzed a large multicenter registry (ESCR MR/CT Registry) of stable symptomatic patients who received CCTA 01/2010–01/2020 at 47 (22%) academic and 165 (78%) non-academic sites across 19 European countries. We compared image quality, radiation dose, contrast-media-related adverse events, patient characteristics, CCTA findings, and downstream testing between academic and non-academic sites.

Results

Among 64,317 included patients (41% female; 60 ± 13 years), academic sites accounted for most cases in 2010–2014 (52%), while non-academic sites dominated in 2015–2020 (71%). Despite less contemporary technology, non-academic sites maintained low radiation doses (4.76 [2.46–6.85] mSv) with a 30% decline of high-dose scans ( > 7 mSv) over time. Academic and non-academic sites both reported diagnostic image quality in 98% of cases and low rate of scan-related adverse events (0.4%). Academic and non-academic sites examined similar patient populations (41% females both; age: 61 ± 14 vs. 60 ± 12 years; pretest probability for obstructive CAD: low 21% vs. 23%, intermediate 73% vs. 72%, high 6% both, CAD prevalence on CCTA: 40% vs. 41%). Nevertheless, non-academic sites referred more patients to non-invasive ischemia testing (6.5% vs. 4.2%) and invasive coronary angiography/surgery (8.5% vs. 5.6%).

Conclusions

Non-academic and academic sites provide safe, high-quality CCTA across Europe, essential to successfully implement the recently updated guidelines for the diagnosis and management of chronic coronary syndromes. However, despite examining similar populations with comparable CAD prevalence, non-academic sites tend to refer more patients to downstream testing.

Key Points

Smaller non-academic providers increasingly use CCTA to rule out obstructive coronary artery disease.

Non-academic and academic sites provide comparably safe, high-quality CCTA across Europe.

Compared to academic sites, non-academic sites tend to refer more patients to downstream testing.

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Abbreviations

AE:

Adverse events

CAC:

Coronary artery calcium

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CT:

Computed tomography

DLP:

Dose length product

ESC:

European Society of Cardiology

ESCR:

European Society of Cardiovascular Radiology

NICE:

National Institute for Health and Care Excellence

PTP:

Pretest probability

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Acknowledgements

We thank the clinical and research personnel for the continuous hard work on extending the ESCR MR/CT registry. The authors acknowledge the help of the ESCR office Vienna, Austria and LoeScap Technology GmbH, Berlin, Germany.

Funding

The ESCR MRCT Registry received unrestricted educational funding from Siemens Healthineers, Erlangen, Germany; Bayer Healthcare, Leverkusen, Germany; Philips, Amsterdam, the Netherlands; and Bracco, Milan, Italy.

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Correspondence to Borek Foldyna.

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The scientific guarantor of this publication is Dr. Matthias Gutberlet.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the institutional review board.

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• Retrospective

• Observational

• Multicenter observational cohort study

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Borek Foldyna and Johannes Uhlig share first authorship.

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Foldyna, B., Uhlig, J., Gohmann, R. et al. Quality and safety of coronary computed tomography angiography at academic and non-academic sites: insights from a large European registry (ESCR MR/CT Registry). Eur Radiol 32, 5246–5255 (2022). https://doi.org/10.1007/s00330-022-08639-0

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  • DOI: https://doi.org/10.1007/s00330-022-08639-0

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