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

Rudziński, Paweł; Kruk, Mariusz; Kępka, Cezary; Schoepf, U. Joseph; Otani, Katharina; Leonard, Tyler J.; Dębski, Mariusz; Dzielińska, Zofia; Pręgowski, Jerzy; Witkowski, Adam; Rużyłło, Witold; Demkow, Marcin

doi:10.1016/j.jcct.2019.07.008

Cited by 15 publications

(10 citation statements)

References 21 publications

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“…However, subgroup analysis did not yield any significant differences between the RCA-aorta angles of normal cases, or those with <50% and ≥50% coronary stenosis. Degree of coronary stenosis is commonly used in the current literature to characterise CAD severity (25,26,(28)(29)(30). However, this alone is not necessarily indicative of ischemic severity, which is an inherent limitation for CCTA, as the degree of coronary stenosis does not always translate to the hemodynamic significance of coronary lesions.…”

Section: Discussionmentioning

confidence: 99%

Coronary computed tomography angiography assessment of relationship between right coronary artery-aorta angle and the development of coronary artery disease

Geerlings-Batt¹,

Sun²

2023

Quant Imaging Med Surg

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Whilst a correlation has been established between wide left main coronary artery bifurcation[left anterior descending-left circumflex (LAD-LCx)] angle (>80°) and the development of coronary artery disease (CAD), this retrospective, causal-comparative pilot study aimed to explore whether a relationship exists between right coronary artery (RCA)-aorta angle and CAD. Thirty normal cases were identified via radiology reports and selected as the control group with coronary computed tomography angiography (CCTA) scans performed on a 320-slice computed tomography (CT) scanner. Thirty CAD cases were selected with invasive coronary angiography performed to confirm the degree of stenosis, and CCTA performed on dual source and 320-slice CT scanners. An independent sample t-test was used to compare the differences in coronary angles between the normal and CAD group, and analysis of variance (ANOVA) was used to assess for significant differences between coronary angles in normal and CAD subgroups. Coronary angle measurements were conducted by two independent assessors with high intraclass correlation (r=0.971-0.998, P<0.001). RCA-aorta angle measurements were significantly larger in the normal group [87.47°, 95% confidence interval (CI): 79.31° to 95.78°] compared to the CAD group (76.82°, 95% CI: 67.82° to 85.61°, P=0.05). No significant difference was found between RCA-aorta angle and degree of coronary stenosis (P=0.75). This study suggests a relationship between narrow RCA-aorta angle and CAD.

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Section: Discussionmentioning

confidence: 99%

Coronary computed tomography angiography assessment of relationship between right coronary artery-aorta angle and the development of coronary artery disease

Geerlings-Batt¹,

Sun²

2023

Quant Imaging Med Surg

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“… 23 Furthermore, this strategy would offer an estimated cost savings of US$1,149,712 even if all 794 patients underwent a CCTA as an alternative test (direct cost difference is US$1448 less for CCTA compared to invasive angiogram) every year in this health region. 24 Given that all 794 patients may not be candidates for CCTA (ie, atrial fibrillation as a contraindication in approximately 10%) or may have an inadequate assessment (ie, high calcium score), the real-world benefits may be more modest but still significant. External validation of this predictive model, incorporation into a user-friendly decision support program, and evaluation of implementation are required next steps prior to scale and spread of this model.…”

Section: Discussionmentioning

confidence: 99%

A machine learning–based clinical decision support algorithm for reducing unnecessary coronary angiograms

Schwalm

Sheth

et al. 2022

Cardiovascular Digital Health Journal

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“…Sixty patients from the coronary CTA arm of the randomized CAT-CAD trial were analyzed. [2][3][4] Individuals with coronary artery stenoses in a range of 40% to 90% were selected and retrospectively evaluated with FFR-CT. Afterward, the investigators selected the most appropriate clinical management based on FFR-CT results in order to investigate the effect of noninvasive functional coronary assessment on the reclassification rate and management plan compared to the routine clinical management (Fig.…”

Section: Methodsmentioning

confidence: 99%

Can the Application of Fractional Flow Reserve Computed Tomography in High-risk Patients With Chronic Coronary Syndrome Obviate Downstream Diagnostic Invasive Coronary Procedures?

Rudziński

Kruk

Dębski

et al. 2023

Journal of Thoracic Imaging

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F ollowing the diagnostic success of noninvasive coronary computed tomography angiography (CTA) assessment of coronary anatomy, the additional value of coronary CTA-based fractional flow reserve (FFR-CT) promises to reduce the number of downstream invasive diagnostic procedures in patients with intermediate stenosis on coronary CTA. 1 However, current trials and analyses concerning coronary CTA and FFR-CT are based on the population of patients with low and intermediate probabilities of obstructive coronary artery disease (CAD). Growing experience with FFR-CT, its recent introduction into clinical practice guidelines, and technological improvements in coronary CT imaging may well predict an impending decline of purely diagnostic invasive coronary angiography (ICA) in stable patients even with a high probability of CAD.

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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

Cited by 15 publications

References 21 publications

Coronary computed tomography angiography assessment of relationship between right coronary artery-aorta angle and the development of coronary artery disease

Coronary computed tomography angiography assessment of relationship between right coronary artery-aorta angle and the development of coronary artery disease

A machine learning–based clinical decision support algorithm for reducing unnecessary coronary angiograms

Can the Application of Fractional Flow Reserve Computed Tomography in High-risk Patients With Chronic Coronary Syndrome Obviate Downstream Diagnostic Invasive Coronary Procedures?

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