open access

Online first
Original article
Published online: 2021-12-19
Get Citation

Efficacy and safety of coronary computed tomography angiography in patients with a high clinical likelihood of obstructive coronary artery disease

Piotr Nikodem Rudziński1, Mariusz Kruk1, Marcin Demkow1, Anna Oleksiak1, Joseph U Schoepf23, Markus Mach4, Zofia Dzielińska1, Jerzy Pręgowski1, Adam Witkowski1, Witold Rużyłło1, Cezary Kępka1
DOI: 10.33963/KP.a2021.0185
·
Pubmed: 34923618
Affiliations
  1. National Institute of Cardiology, Warszawa, Poland
  2. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
  3. Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
  4. Division of Cardiac Surgery, Department of Surgery, Vienna General Hospital, Vienna, Austria

open access

Online first
Original article
Published online: 2021-12-19

Abstract

Background: The CAT-CAD trial showed that coronary computed tomography angiography (CTA) in patients with a high prevalence of coronary artery disease (CAD) and indications for invasive coronary angiography (ICA) reduces the number of patients undergoing ICA by two thirds and nearly eradicates non-actionable ICAs. However, the long-term benefits of this non-invasive strategy remain unknown.

Aims: To evaluate the long-term efficacy and safety of a non-invasive strategy employing coronary CTA vs. ICA as the first-line imaging test in stable patients with a high clinical likelihood of obstructive CAD.

Methods: The long-term outcomes were evaluated during 36 months following randomization and included the efficacy outcome, analyzed as the composite of major adverse cardiovascular events (MACE): all-cause death, acute coronary syndrome, unplanned coronary revascularization, urgent hospitalization for cardiovascular reason, stroke, and the safety outcome, analyzed as a cumulative incidence of serious adverse events.

Results: 120 participants with a mean age of 60.6 (7.9) years (female, 35.0%) were randomized with an allocation ratio of 1:1 to coronary CTA and direct ICA as the first-line anatomical test for suspected obstructive CAD. There were no significant differences between both diagnostic strategies neither in terms of the long-term efficacy (MACE occurrence: 15.5% in coronary CTA group vs. 16.7% in ICA group; log-rank P = 0.89) nor the long-term safety (cumulative number of serious adverse events: respectively 36 vs. 38; P = 0.79).

Conclusions: Long-term follow-up of the randomized CAT-CAD trial confirms that the strategy employing coronary CTA is an effective and safe, non-invasive, outpatient-based alternative to ICA for patients with a high clinical likelihood of obstructive CAD.

Abstract

Background: The CAT-CAD trial showed that coronary computed tomography angiography (CTA) in patients with a high prevalence of coronary artery disease (CAD) and indications for invasive coronary angiography (ICA) reduces the number of patients undergoing ICA by two thirds and nearly eradicates non-actionable ICAs. However, the long-term benefits of this non-invasive strategy remain unknown.

Aims: To evaluate the long-term efficacy and safety of a non-invasive strategy employing coronary CTA vs. ICA as the first-line imaging test in stable patients with a high clinical likelihood of obstructive CAD.

Methods: The long-term outcomes were evaluated during 36 months following randomization and included the efficacy outcome, analyzed as the composite of major adverse cardiovascular events (MACE): all-cause death, acute coronary syndrome, unplanned coronary revascularization, urgent hospitalization for cardiovascular reason, stroke, and the safety outcome, analyzed as a cumulative incidence of serious adverse events.

Results: 120 participants with a mean age of 60.6 (7.9) years (female, 35.0%) were randomized with an allocation ratio of 1:1 to coronary CTA and direct ICA as the first-line anatomical test for suspected obstructive CAD. There were no significant differences between both diagnostic strategies neither in terms of the long-term efficacy (MACE occurrence: 15.5% in coronary CTA group vs. 16.7% in ICA group; log-rank P = 0.89) nor the long-term safety (cumulative number of serious adverse events: respectively 36 vs. 38; P = 0.79).

Conclusions: Long-term follow-up of the randomized CAT-CAD trial confirms that the strategy employing coronary CTA is an effective and safe, non-invasive, outpatient-based alternative to ICA for patients with a high clinical likelihood of obstructive CAD.

Get Citation

Keywords

chronic coronary syndrome, coronary artery disease, coronary computed tomography angiography, invasive coronary angiography, percutaneous coronary intervention

About this article
Title

Efficacy and safety of coronary computed tomography angiography in patients with a high clinical likelihood of obstructive coronary artery disease

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2021-12-19

DOI

10.33963/KP.a2021.0185

Pubmed

34923618

Keywords

chronic coronary syndrome
coronary artery disease
coronary computed tomography angiography
invasive coronary angiography
percutaneous coronary intervention

Authors

Piotr Nikodem Rudziński
Mariusz Kruk
Marcin Demkow
Anna Oleksiak
Joseph U Schoepf
Markus Mach
Zofia Dzielińska
Jerzy Pręgowski
Adam Witkowski
Witold Rużyłło
Cezary Kępka

References (20)
  1. Rudziński PN, Kruk M, Kępka C, et al. The value of Coronary Artery computed Tomography as the first-line anatomical test for stable patients with indications for invasive angiography due to suspected Coronary Artery Disease: CAT-CAD randomized trial. J Cardiovasc Comput Tomogr. 2018; 12(6): 472–479.
  2. Genders TSS, Steyerberg EW, Alkadhi H, et al. A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. Eur Heart J. 2011; 32(11): 1316–1330.
  3. Patel MR, Peterson ED, Dai D, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010; 362(10): 886–895.
  4. Barbato E, Dudek D, Baumbach A, et al. EAPCI registries: a first step towards systematic monitoring of European interventional cardiology practice. EuroIntervention. 2017; 13(Z): Z6–Z7.
  5. Foldyna B, Udelson JE, Karády J, et al. Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial. Eur Heart J Cardiovasc Imaging. 2019; 20(5): 574–581.
  6. Knuuti J, Wijns W, Saraste A, et al. et al.. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41(3): 407–477.
  7. Baumbach A, Bourantas CV, Serruys PW, et al. The year in cardiology: coronary interventions. Eur Heart J. 2020; 41(3): 394–405.
  8. Reeh J, Therming CB, Heitmann M, et al. Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina. Eur Heart J. 2019; 40(18): 1426–1435.
  9. Rudziński PN, Kruk M, Kępka C, et al. Assessing the value of coronary artery computed tomography as the first-line anatomical test for stable patients with indications for invasive angiography due to suspected coronary artery disease. Initial cost analysis in the CAT-CAD randomized trial. J Cardiovasc Comput Tomogr. 2020; 14(1): 75–79.
  10. Chang HJ, Lin FY, Gebow D, et al. Selective referral using CCTA versus direct referral for individuals referred to Invasive coronary angiography for Suspected CAD: a randomized, controlled, open-label trial. JACC Cardiovasc Imaging. 2019; 12(7 Pt 2): 1303–1312.
  11. Kruk M, Rudziński PN, Demkow M, et al. Is the Majority Benefitting at the Costs of the Minority Among Patients Undergoing CTA as the First-Line Diagnostic in Highly Suspected Coronary Artery Disease? J Am Coll Cardiol Img. 2019; 12(5): 944.
  12. Newby D, Williams D, Pawade T, et al. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOTHEART): an open-label, parallel-group, multicenter trial. Lancet. 2015; 385(9985): 2383–2391.
  13. Douglas PS, Hoffmann U, Patel MR, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015; 372(14): 1291–1300.
  14. Douglas PS, De Bruyne B, Pontone G, et al. 1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary Disease: The PLATFORM Study. J Am Coll Cardiol. 2016; 68(5): 435–445.
  15. Moscariello A, Vliegenthart R, Schoepf UJ, et al. Coronary CT angiography versus conventional cardiac angiography for therapeutic decision making in patients with high likelihood of coronary artery disease. Radiology. 2012; 265(2): 385–392.
  16. Dewey M, Rief M, Martus P, et al. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial. BMJ. 2016; 355: i5441.
  17. Achenbach S. Coronary CTA and percutaneous coronary intervention - A symbiosis waiting to happen. J Cardiovasc Comput Tomogr. 2016; 10(5): 384–385.
  18. Hou Y, Ma Y, Fan W, et al. Diagnostic accuracy of low-dose 256-slice multi-detector coronary CT angiography using iterative reconstruction in patients with suspected coronary artery disease. Eur Radiol. 2014; 24(1): 3–11.
  19. van Hamersvelt RW, Eijsvoogel NG, Mihl C, et al. Contrast agent concentration optimization in CTA using low tube voltage and dual-energy CT in multiple vendors: a phantom study. Int J Cardiovasc Imaging. 2018; 34(8): 1265–1275.
  20. Serruys PW, Hara H, Garg S, et al. Coronary computed tomographic angiography for complete assessment of coronary artery disease: JACC state-of-the-art review. J Am Coll Cardiol. 2021; 78(7): 713–736.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Sp. z o.o. VM Group Sp.k., ul. Świętokrzyska 73 , 80–180 Gdańsk, Poland

phone:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl