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Coronary computed tomography angiography (CCTA) in patients with suspected stable coronary artery disease (CAD): diagnostic impact and clinical consequences in the German Cardiac CT Registry depending on stress test results

Abstract

To evaluate diagnostic impact of clinical use of coronary computed tomography angiography (CCTA) in patients with suspected stable coronary artery disease (CAD) and its consequences in daily practice for patient management, depending on stress test results in daily practice. Between 2009 and 2014 of a total population of 1352 patients of the German Cardiac Computed Tomography (CT) Registry who had previously undergone stress tests, CCTA visualizations were carried out on the coronary arteries with suspected stable CAD. Patients were divided into three groups according to stress test results: Group 1 with inconclusive (n = 178, 13.2%), Group 2 with ischemia in stress test (n = 372, 27.5%) and Group 3 without ischemia in stress test (n = 802, 59.3%). The test of preference was the stress electrocardiogram (ECG), which was performed more frequently in patients without ischemia in stress test as compared to those with ischemia (96.3% vs. 93.0%, p = 0.015). The incidence of detected obstructive CAD was lower in patients with suggested ischemia in stress test as compared to patients with inconclusive results (14.1% vs. 21.1%, p = 0.037). There was no difference in the incidence of an obstructive CAD in patients with and without ischemia in stress test (14.1% vs. 15.8%, p = 0.440). CCTA is a reliable, non-invasive option for ruling-out obstructive CAD irrespective of the stress test result.

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Acknowledgements

We are indebted to all participants of the registry and the staff of the Stiftung Institut für Herzinfarktforschung of Ludwigshafen, Germany.

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Correspondence to Sebastian Barth.

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Conflict of interest

Stephan Achenbach has received research grants from Siemens Healthcare. Mohamed Marwan has received speaker honoraria from Siemens Healthcare. All patients at participating sites gave written informed consent for CT scan and inclusion in the registry. The registry was approved by the participating institution's IRBs.

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Barth, S., Marwan, M., Hausleiter, J. et al. Coronary computed tomography angiography (CCTA) in patients with suspected stable coronary artery disease (CAD): diagnostic impact and clinical consequences in the German Cardiac CT Registry depending on stress test results. Int J Cardiovasc Imaging 35, 741–748 (2019). https://doi.org/10.1007/s10554-018-1504-0

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  • DOI: https://doi.org/10.1007/s10554-018-1504-0

Keywords

  • Coronary computed tomography angiography
  • Stress test
  • Stable coronary artery disease
  • Pre-test probability