Quality and safety of coronary computed tomography angiography at academic and non-academic sites: insights from a large European registry (ESCR MR/CT Registry)

Abstract

Objectives To compare the use of coronary computed tomography angiography (CCTA) between academic and non-academic sites across Europe over the last decade. Methods We analyzed a large multicenter registry (ESCR MR/CT Registry) of stable symptomatic patients who received CCTA 01/2010-01/2020 at 47 (22%) academic and 165 (78%) non-academic sites across 19 European countries. We compared image quality, radiation dose, contrast-media-related adverse events, patient characteristics, CCTA findings, and downstream testing between academic and non-academic sites. Results Among 64,317 included patients (41% female; 60 ± 13 years), academic sites accounted for most cases in 2010-2014 (52%), while non-academic sites dominated in 2015-2020 (71%). Despite less contemporary technology, non-academic sites maintained low radiation doses (4.76 [2.46-6.85] mSv) with a 30% decline of high-dose scans ( > 7 mSv) over time. Academic and non-academic sites both reported diagnostic image quality in 98% of cases and low rate of scan-related adverse events (0.4%). Academic and non-academic sites examined similar patient populations (41% females both; age: 61 ± 14 vs. 60 ± 12 years; pretest probability for obstructive CAD: low 21% vs. 23%, intermediate 73% vs. 72%, high 6% both, CAD prevalence on CCTA: 40% vs. 41%). Nevertheless, non-academic sites referred more patients to non-invasive ischemia testing (6.5% vs. 4.2%) and invasive coronary angiography/surgery (8.5% vs. 5.6%). Conclusions Non-academic and academic sites provide safe, high-quality CCTA across Europe, essential to successfully implement the recently updated guidelines for the diagnosis and management of chronic coronary syndromes. However, despite examining similar populations with comparable CAD prevalence, non-academic sites tend to refer more patients to downstream testing. Key Points• Smaller non-academic providers increasingly use CCTA to rule out obstructive coronary artery disease.• Non-academic and academic sites provide comparably safe, high-quality CCTA across Europe.• Compared to academic sites, non-academic sites tend to refer more patients to downstream testing.

German Radiological Society and the Professional Association of German Radiologists Position Paper on Coronary computed tomography: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome

“…Foldyna et al haben die CT des Herzens hinsichtlich der Bildqualität und Sicherheit in über 64 000 Patienten basierend auf der ESCR MR/CT Datenbank in akademischen und nicht-akademischen Krankenhäusern analysiert. Eine diagnostische Bildqualität wurde in > 98 % der Fälle berichtet, die Scan-bezogenen Komplikationen sind mit 0,4 % sehr gering [132].…”

Positionspapier von DRG und BDR zur Computertomographie des Herzens: Klinische Evidenz und Versorgungsqualität beim chronischen Koronarsyndrom

“…Auch der europäische Vergleich ist an dieser Stelle interessant. Foldyna et al [ 132 ] haben die CT des Herzens hinsichtlich der Bildqualität und Sicherheit in über 64.000 Patienten basierend auf der ESCR MR/CT Datenbank in akademischen und nicht-akademischen Krankenhäusern analysiert. Eine diagnostische Bildqualität wurde in > 98 % der Fälle berichtet, die Scan-bezogenen Komplikationen sind mit 0,4 % sehr gering.…”

Clinical Utilization of Multimodality Imaging for Myocarditis and Cardiac Sarcoidosis

“…According to the European Society of Cardiovascular Radiology MR/Computed Tomography (CT)-registry, both suspected myocarditis and CS together with suspected or known cardiomyopathies are the major indications for CMR and account for >30% of all CMR examinations. 45,46…”