title: Patients With Suspected Coronary Artery Disease Referred for Examinations in the Era of Coronary Computed Tomography Angiography.
abstract: Invasive coronary angiography (ICA) is the gold standard in the diagnosis of coronary artery disease (CAD), however, associated with rare but severe complications. Patients with a high pretest risk should be referred directly for ICA, whereas a noninvasive strategy is recommended in the remaining patients. In the setting of a university hospital, we investigated the pattern of diagnostic tests used in daily clinical practice. During a 1-year period, consecutive patients with new symptoms suggestive of CAD and referred for exercise stress test, coronary computed tomography angiography (CCTA), single-photon emission computed tomography (SPECT), or ICA qualified for inclusion. The patients were followed for 1 year, and additional downstream diagnostic tests and need of coronary revascularization were registered. A total of 1,069 patients were included. A noninvasive test was the first examination in 797 patients (75%; exercise stress test in 37, CCTA in 450, and SPECT in 310), whereas 272 (25%) were referred directly to ICA. The ICA group had a significant higher pretest probability for CAD, and the percentage of patients with evidence of significant CAD was 31% (84 of 272 patients), whereas 18% (144 of 797 patients) in the noninvasive group (p <0.0001). In the comparison between CCTA and SPECT, there were no significant differences in downstream testing (16% [72 of 444 patients] vs 17% [53 of 310], p = 0.55), and revascularization rate (20% [14 of 69 patients with positive findings] vs 9% [6 of 67], p = 0.09). In conclusion, a noninvasive diagnostic test was chosen as the first test in 3 of 4 patients. Of the patients referred directly for noninvasive examination, 1/5 had significant CAD, whereas 1/3 of those for invasive examination.
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Ajda
authors.initials: A
authors.lastname: Zorlak
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Amet
authors.initials: A
authors.lastname: Zorlak
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Thomassen
authors.affiliation: Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: Oke
authors.initials: O
authors.lastname: Gerke
authors.affiliation: Department of Cardiology, Vejle Hospital, Vejle, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Munkholm
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Mickley
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: axel.diederichsen@rsyd.dk.
authors.forename: Axel C Pyndt
authors.initials: AC
authors.lastname: Diederichsen
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*