Carlos González-Freixa, Francesc Altadill Balsells, Lidia Bos Real, Martín Descalzo Buey, Juan Fernández Martínez, Mario Salido Iniesta, Konrad Pieszko, Ruben Leta Petracca, David Viladés Medel
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引用次数: 0
Abstract
Objectives: Coronary computed tomography angiography (CCTA) is highly effective for detecting coronary artery disease (CAD) but cannot assess its hemodynamic significance, often requiring additional tests. This study evaluates the clinical performance and cost-effectiveness of integrating dynamic myocardial CT perfusion (DynCTP) into the assessment of symptomatic patients with suspected CAD or prior chronic coronary syndrome (CCS).
Materials and methods: We conducted a single center, retrospective study comparing two matched cohorts. In the first cohort patients underwent CCTA followed by non-CT-based functional tests, while in the second cohort DynCTP was included for cases of potential functionally significant CAD. The study analyzed the number of additional tests, diagnostic process duration, and the incidence of major adverse cardiovascular events. A probabilistic cost analysis was performed to evaluate the economic impact.
Results: A total of 205 patients were included, 71% of whom were male, with a mean age of 72.5 ± 10 years. Over a follow-up of 30 months, the CCTA+DynCTP cohort showed a 56% reduction in additional tests and 45% in time to clinical decision-making, with a higher proportion of patients requiring only the initial study. No significant differences were observed in the number of invasive coronary angiograms or major adverse clinical events, although an increase in overall healthcare costs was documented.
Conclusion: Integrating DynCTP into the evaluation of symptomatic patients with suspected CAD or prior CCS streamlines the diagnostic process compared to a strategy based on CCTA and other functional tests, reducing time and additional testing without increasing adverse outcomes, although it is associated with slightly higher healthcare costs.
Key points: Question Evaluating the hemodynamic significance of coronary artery stenosis identified by coronary CT angiography is important to determine the best treatment strategy, but requires complementary tests. Findings DynCTP reduced the time to clinical decision-making and the need for additional testing without increasing major adverse cardiovascular events. Clinical relevance The integration of DynCTP safely streamlines the diagnostic process of CAD compared to a strategy based on CCTA and additional functional tests.
期刊介绍:
European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field.
This is the Journal of the European Society of Radiology, and the official journal of a number of societies.
From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.