title: Repeat coronary computed tomographic angiography in patients with a prior scan excluding significant stenosis.
abstract: BACKGROUND
  ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography (AUC2010) does not incorporate prior coronary computed tomographic angiography (CCTA) results in the appropriateness of a CCTA examination. The purpose of this study was to explore the criteria for forgoing repeat CCTA among patients with clinical scenarios suggesting CCTA as appropriate after prior CCTA excluding coronary artery disease.
  
  
  RESULTS
  Among patients from a single center (February 2006 to April 2013) who underwent appropriate CCTA based on AUC2010, consecutive 555 CCTAs, which had a prior CCTA excluding significant stenosis (>50% stenosis in diameter), were selected. The median time difference between the studies was 34.2 (Q1-Q3, 22.9-50.1) months. Significant stenosis was detected at the time of repeat scan (by CCTA or subsequent catheter angiography) in 13.3% (74 of 555). A multivariable logistic model (C-statistic, 0.74; bootstrapped overfitting bias, 0.8%) identified 3 predictors of significant stenosis: time difference between the studies >3 years (adjusted odds ratio, 2.1; 95% confidence interval, 1.2-3.5), diabetes mellitus (odds ratio, 2.4; 95% confidence interval,1.4-4.3), and 26% to 50% stenosis on the initial CCTA (odds ratio, 5.6; 95% confidence interval, 3.2-9.6). When these 3 factors were all absent (corresponding to 31.9% of the population), the probability of significant stenosis was 4.5% (95% confidence interval, 2.7-7.4%), whereas 17.1% of patients had significant stenosis among those with at least 1 positive variable. When coronary arteries were completely normal at the initial scan, the prevalence of significant stenosis was only 1.8% irrespective of other factors, and no patient underwent revascularization.
  
  
  CONCLUSIONS
  Nondiabetic patients with a prior CCTA <3 years showing no or ≤25% stenosis had a <5% prevalence of significant stenosis. The value of repeat CCTA in this group is likely small, especially when the prior CCTA demonstrated normal coronaries, even if the clinical scenario considered a CCTA appropriate.
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.K.K., E.G., F.J.R.); Department of Cardiology (T.K.) and Department of Radiology (M.A.), Takase Clinic, Takasaki, Japan; and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.).
authors.forename: Kanako K
authors.initials: KK
authors.lastname: Kumamaru
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.K.K., E.G., F.J.R.); Department of Cardiology (T.K.) and Department of Radiology (M.A.), Takase Clinic, Takasaki, Japan; and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.).
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kondo
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.K.K., E.G., F.J.R.); Department of Cardiology (T.K.) and Department of Radiology (M.A.), Takase Clinic, Takasaki, Japan; and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.).
authors.forename: Hiraku
authors.initials: H
authors.lastname: Kumamaru
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.K.K., E.G., F.J.R.); Department of Cardiology (T.K.) and Department of Radiology (M.A.), Takase Clinic, Takasaki, Japan; and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.).
authors.forename: Makoto
authors.initials: M
authors.lastname: Amanuma
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.K.K., E.G., F.J.R.); Department of Cardiology (T.K.) and Department of Radiology (M.A.), Takase Clinic, Takasaki, Japan; and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.).
authors.forename: Elizabeth
authors.initials: E
authors.lastname: George
authors.affiliation: From the Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.K.K., E.G., F.J.R.); Department of Cardiology (T.K.) and Department of Radiology (M.A.), Takase Clinic, Takasaki, Japan; and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.K.). frybicki@partners.org.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: coronary artery disease; coronary vessels; multidetector computed tomography; risk factors