国际心血管研究杂志

The Impact of Appropriate Use of Coronary Cardiac Computed Tomography on Downstream Resource Utilization and Patient Management

Tae Yang, Mahmoud Assaad, Ashley VanSlooten, Meredith Mahan and Karthik Ananthasubramaniam

The Impact of Appropriate Use of Coronary Cardiac Computed Tomography on Downstream Resource Utilization and Patient Management

Background: The effects of appropriate use (AUC) of cardiac computed tomography angiography (CCTA) on downstream resource utilization, coronary angiography, revascularization, and medication changes are not well studied in daily practice.

Methods: Single center study to address AUC CCTA impact on downstream resource utilization. CCTA studies classified according to 2010 AUC as appropriate, inappropriate, or uncertain and its impact on downstream resource utilization and management was evaluated at 90 days and 1 year.

Results: Overall, 402 (87.8%) of the studies were appropriate, 37 (8.1%) were inappropriate, and 19 (4.2%) were uncertain. Additional cardiac testing at 90 days (5.2% vs. 10.8%, p=0.149) and 12 months (13.9% vs. 21.6%, p=0.205) were similar among all 3 groups. Significantly more patients in the inappropriate group underwent coronary angiography (21.6% vs. 9.7%, p=0.045), but revascularization rates were similar (8.1% vs. 5.0%, p=0.43). There was greater cardiac medication initiation once coronary artery disease was detected by CCTA (52.4% vs. 5.5%, p<0.0001) overall.

Conclusions: Our study did not show a downstream impact of AUCbased CCTA with regards to diagnostic testing or revascularization; however, higher referral for coronary angiography was found in the inappropriate group likely reflecting intrinsic higher risk group inappropriately referred to CCTA. Cardiac medication initiation to reduce perceived future risk was detected across all groups when coronary artery disease was detected by CCTA. Individual practices should audit their CCTA performance using AUC to identify areas for improvement in utilization of CCTA.