title: Impact of Clinical Guideline Recommendations on the Application of Coronary Computed Tomographic Angiography in Patients with Suspected Stable Coronary Artery Disease.
abstract: BACKGROUND
  Coronary computed tomographic angiography (CCTA) has been widely used in patients who are at intermediate risk for having stable coronary artery disease (SCAD), and 2013 European Society of Cardiology Guidelines on the Management of SCAD (2013G) recommended the appropriate application of CCTA. However, 2013G has not been subjected to systematic analyses for subsequent impact on clinical practice.
  
  
  METHODS
  A total of 5320 patients suspected with SCAD were enrolled and scheduled for CCTA from March 2013 to September 2014. For each patient, pretest probability of SCAD was calculated according to updated Diamond-Forrester model (UDFM). Appropriate CCTA or appropriate stress test was determined as described in the 2013G. A generalized estimating equation model was used to determine the trends in the half-monthly rate of appropriate CCTA.
  
  
  RESULTS
  Overall, only 61.37% of patients received appropriate CCTA, and there was insignificant change over time (P = 0.8701). The application of CCTA in patients who should have had a stress test accounted for most of the inappropriate CCTA before (22.29%) or after (19.98%) the publication of the 2013G. In all patients or any subgroup, no significant change in the adjusted half-monthly rate of appropriate CCTA was found after the publication of the 2013G (odds ratio, 1.002; 95% confidence interval, 0.982-1.021; P = 0.8678).
  
  
  CONCLUSIONS
  These findings suggest that the 2013G have not, to date, been fully incorporated into clinical practice, and the clinical utilization of CCTA remains unreasonable to some extent.
authors.forename: Jia
authors.initials: J
authors.lastname: Zhou
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Yang
authors.forename: Xia
authors.initials: X
authors.lastname: Yang
authors.forename: Zhi-Ye
authors.initials: ZY
authors.lastname: Chen
authors.forename: Bai
authors.initials: B
authors.lastname: He
authors.forename: Luo-Shan
authors.initials: LS
authors.lastname: Du
authors.affiliation: Department of Cardiology, PLA General Hospital, Beijing 100853, China.
authors.forename: Yun-Dai
authors.initials: YD
authors.lastname: Chen
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio
references.citation: J Am Coll Cardiol. 2014 Feb 4;63(4):380-406
references.pmid: 24355759
references.citation: Circulation. 2011 Nov 29;124(22):2377-9
references.pmid: 22125189
references.citation: Atherosclerosis. 2014 Jun;234(2):426-35
references.pmid: 24769305
references.citation: J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):198-204
references.pmid: 24939068
references.citation: Am J Cardiol. 2014 Jul 15;114(2):305-11
references.pmid: 24874162
references.citation: JAMA. 1999 Oct 20;282(15):1458-65
references.pmid: 10535437
references.citation: Lancet. 2003 Oct 11;362(9391):1225-30
references.pmid: 14568747
references.citation: Ann Intern Med. 1993 Jan 15;118(2):81-90
references.pmid: 8416322
references.citation: BMC Fam Pract. 2007;8:1
references.pmid: 17201905
references.citation: Eur Radiol. 2007 May;17(5):1301-9
references.pmid: 17031453
references.citation: J Am Coll Cardiol. 2007 Oct 9;50(15):1469-75
references.pmid: 17919567
references.citation: N Engl J Med. 2008 Nov 27;359(22):2309-11
references.pmid: 19038877
references.citation: J Cardiovasc Comput Tomogr. 2009 Mar-Apr;3(2):67-70
references.pmid: 19201673
references.citation: J Cardiovasc Comput Tomogr. 2009 Mar-Apr;3(2):122-36
references.pmid: 19272853
references.citation: Radiology. 2009 Dec;253(3):734-44
references.pmid: 19864509
references.citation: J Cardiovasc Comput Tomogr. 2009 Nov-Dec;3(6):386-91
references.pmid: 20083058
references.citation: Radiology. 2010 Mar;254(3):801-8
references.pmid: 20177094
references.citation: Arch Cardiovasc Dis. 2011 Jan;104(1):29-34
references.pmid: 21276575
references.citation: J Am Coll Cardiol. 2011 Mar 8;57(10):1237-47
references.pmid: 21145688
references.citation: Eur Heart J. 2011 Jun;32(11):1316-30
references.pmid: 21367834
references.citation: Arch Intern Med. 2011 Oct 10;171(18):1636-43
references.pmid: 21747002
references.citation: Circulation. 2011 Nov 29;124(22):2423-32, 1-8
references.pmid: 22025600
references.citation: Eur Heart J. 2013 Oct;34(38):2949-3003
references.pmid: 23996286
references.citation: Am J Cardiol. 2013 Jul 15;112(2):208-11
references.pmid: 23623289
references.citation: Eur Heart J. 2013 May;34(17):1262-9
references.pmid: 23376448
references.citation: BMJ. 2012;344:e3485
references.pmid: 22692650
references.citation: Am J Cardiol. 2012 Apr 1;109(7):998-1004
references.pmid: 22236462
references.citation: Atherosclerosis. 2012 Feb;220(2):557-62
references.pmid: 22189201
references.citation: J Am Coll Cardiol. 2014 Apr 8;63(13):1264-74
references.pmid: 24509269