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A recent study presented at the American College of Cardiology Cardiovascular Summit suggests that implementing the World Health Organization’s (WHO) guidelines on using computed tomography angiography (CTA) as the initial diagnostic test for patients with stable chest discomfort could significantly improve outcomes and reduce unnecessary invasive procedures.
Patients experiencing stable angina, a form of chest pain resulting from the heart muscle requiring more oxygen than received, often undergo invasive coronary angiography for further evaluation. However, previous investigations indicated that less than 40% of such patients had obstructive coronary artery disease. In response to this, recent randomized clinical trials have supported the use of CTA as the first-line diagnostic test for these patients.
The pilot study, conducted at Atrium Health-Sanger Heart & Vascular Institute in Charlotte, North Carolina, assessed 786 patients with suspected angina, using different pre-ICA testing strategies, including stress echocardiogram, stress myocardial perfusion imaging, stress MRI, and coronary CTA. The study, led by Markus Scherer, MD, Director of Cardiac CT and Structural Heart Imaging at Atrium Health-Sanger Heart & Vascular Institute, found that the “CT first” strategy was associated with a higher likelihood of subsequent revascularization compared to other modalities or direct ICA referral.
The study cohort, with a mean age of 66 years, included a diverse demographic, and the results demonstrated a significant correlation between the “CT first” strategy and subsequent revascularization. The study aligns with the 2021 AHA/ACC Guideline, suggesting non-invasive functional imaging or coronary CTA as the initial test.
Dr. Scherer emphasized the importance of transitioning to a ‘CT first’ strategy, highlighting its lower risk and cost compared to diagnostic heart catheterization. The approach provides comprehensive information on coronary atherosclerosis, high-risk plaques, and vessel blockages, facilitating efficient patient management and risk reduction.
While acknowledging challenges in transitioning established patterns and variations in patient factors, the study encourages cardiovascular care providers to prioritize the ‘CT first’ approach, emphasizing its cost-effectiveness and potential for streamlined patient care.
As health systems move towards value-oriented healthcare, the study advocates for increased adoption of the ‘CT first’ strategy for evaluating patients with chest pain and an unestablished history of coronary artery disease, ultimately optimizing resource utilization in cardiac catheterization labs.
