Centralized Triage of Suspected Coronary Artery Disease Using Coronary Computed Tomographic Angiography to Optimize the Diagnostic Yield of Invasive Angiography

被引:2
作者
Schwalm, J. -D. [1 ,2 ,3 ,4 ,10 ]
Bouck, Zachary [3 ,5 ]
Natarajan, Madhu K. [1 ,2 ,3 ,4 ]
Pinilla, Natalia [1 ,2 ,3 ,4 ]
Walker, Danielle [3 ,6 ]
Syed, Nida [3 ,6 ]
Landry, David [3 ,6 ]
Sabri, Ali [3 ,7 ]
Tandon, Vikas [2 ,3 ]
Nkurunziza, James [2 ,3 ]
Taljaard, Monica [8 ,9 ]
Sheth, Tej [1 ,2 ,3 ,4 ]
机构
[1] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada
[2] McMaster Univ, Dept Med, Div Cardiol, Hamilton, ON, Canada
[3] Hamilton Hlth Sci, Hamilton, ON, Canada
[4] Niagara Hlth Serv, Dept Med, St Catharines, ON, Canada
[5] Univ Toronto, Dalla Lana Sch Publ Hlth, Epidemiol Div, Toronto, ON, Canada
[6] McMaster Univ, Dept Radiol, Hamilton, ON, Canada
[7] Niagara Hlth Serv, Dept Radiol, St Catharines, ON, Canada
[8] Ottawa Hosp Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada
[9] Univ Ottawa, Epidemiol & Community Med, Ottawa, ON, Canada
[10] Hamilton Gen Hosp Campus, Populat Hlth Res Inst, DBCVSRI, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
关键词
GUIDELINES;
D O I
10.1016/j.cjco.2022.10.009
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Coronary computed tomographic angiography (CCTA) is preferable to invasive coronary angiography (ICA) for coronary artery disease (CAD) diagnosis in elective patients without known CAD.Methods: We conducted a nonrandomized interventional study involving 2 tertiary care centres in Ontario. From July 2018 to February 2020, outpatients referred for elective ICA were identified through a centralized triage process and were recommended to undergo CCTA first instead of ICA. Patients with borderline or obstructive CAD on CCTA were recommended to undergo subsequent ICA. Intervention acceptability, fidelity, and effectiveness were assessed.Results: A total of 226 patients were screened, with 186 confirmed to be eligible, of whom 166 had patient and physician approval to proceed with CCTA (89% acceptability). Among consenting patients, 156 (94%) underwent CCTA first; 43 (28%) had borderline/obstructive CAD on CCTA, and only 1 with normal/nonobstructive CAD on CCTA was referred for subsequent ICA against protocol (99% fidelity). Overall, 119 of 156 CCTA-first patients did not have ICA within the following 90 days (i.e., 76% potentially avoided ICA, due to the intervention). Among the 36 who underwent ICA post-CCTA per protocol, 24 had obstructive CAD (66.7% diagnostic yield). If all patients who were referred for and underwent ICA at either centre between July 2016 and February 2020 (n = 694 pre-implementation; n = 333 post-implementation) had had CCTA first, an additional 42 patients per 100 would have had an obstructive CAD finding on their ICA (95% confidence interval = 2659).Conclusion: A centralized triage process, in which elective outpatients referred for ICA are instead referred for CCTA first, appears to be acceptable and effective in diagnosing obstructive CAD and improving efficiencies in our healthcare system.
引用
收藏
页码:148 / 157
页数:10
相关论文
共 19 条
[1]   Absolute risk reductions, relative risks, relative risk reductions, and numbers needed to treat can be obtained from a logistic regression model [J].
Austin, Peter C. .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 2010, 63 (01) :2-6
[2]  
Biondi MJ, 2021, CIRCULATION, V144
[3]   Why don't physicians follow clinical practice guidelines? A framewouk for improvement [J].
Cabana, MD ;
Rand, CS ;
Powe, NR ;
Wu, AW ;
Wilson, MH ;
Abboud, PAC ;
Rubin, HR .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 282 (15) :1458-1465
[4]  
Canadian Agency for Drugs and Technology in Health, The Canadian Medical Imaging Inventory 2019-2020
[5]   Selective Referral Using CCTA Versus Direct Referral for Individuals Referred to Invasive Coronary Angiography for Suspected CAD A Randomized, Controlled, Open-Label Trial [J].
Chang, Hyuk-Jae ;
Lin, Fay Y. ;
Gebow, Dan ;
An, Hae Young ;
Andreini, Daniele ;
Bathina, Ravi ;
Baggiano, Andrea ;
Beltrama, Virginia ;
Cerci, Rodrigo ;
Choi, Eui-Young ;
Choi, Jung-Hyun ;
Choi, So-Yeon ;
Chung, Namsik ;
Cole, Jason ;
Doh, Joon-Hyung ;
Ha, Sang-Jin ;
Her, Ae-Young ;
Kepka, Cezary ;
Kim, Jang-Young ;
Kim, Jin-Won ;
Kim, Sang-Wook ;
Kim, Woong ;
Pontone, Gianluca ;
Valeti, Uma ;
Villines, Todd C. ;
Lu, Yao ;
Kumar, Amit ;
Cho, Iksung ;
Danad, Ibrahim ;
Han, Donghee ;
Heo, Ran ;
Lee, Sang-Eun ;
Lee, Ji Hyun ;
Park, Hyung-Bok ;
Sung, Ji-min ;
Leflang, David ;
Zullo, Joseph ;
Shaw, Leslee J. ;
Min, James K. .
JACC-CARDIOVASCULAR IMAGING, 2019, 12 (07) :1303-1312
[6]  
CorHealth Ontario, Data holdings and statements of purpose list.
[7]   Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial [J].
Dewey, Marc ;
Rief, Matthias ;
Martus, Peter ;
Kendziora, Benjamin ;
Feger, Sarah ;
Dreger, Henryk ;
Priem, Sascha ;
Knebel, Fabian ;
Boehm, Marko ;
Schlattmann, Peter ;
Hamm, Bernd ;
Schoenenberger, Eva ;
Laule, Michael ;
Zimmermann, Elke .
BMJ-BRITISH MEDICAL JOURNAL, 2016, 355
[8]   Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data [J].
Haase, Robert ;
Schlattmann, Peter ;
Gueret, Pascal ;
Andreini, Daniele ;
Pontone, Gianluca ;
Alkadhi, Hatem ;
Hausleiter, Joerg ;
Garcia, Mario J. ;
Leschka, Sebastian ;
Meijboom, Willem B. ;
Zimmermann, Elke ;
Gerber, Bernhard ;
Schoepf, U. Joseph ;
Shabestari, Abbas A. ;
Norgaard, Bjarne L. ;
Meijs, Matthijs F. L. ;
Sato, Akira ;
Ovrehus, Kristian A. ;
Diederichsen, Axel C. P. ;
Jenkins, Shona M. M. ;
Knuuti, Juhani ;
Hamdan, Ashraf ;
Halvorsen, Bjorn A. ;
Mendoza-Rodriguez, Vladimir ;
Rochitte, Carlos E. ;
Rixe, Johannes ;
Wan, Yung Liang ;
Langer, Christoph ;
Bettencourt, Nuno ;
Martuscelli, Eugenio ;
Ghostine, Said ;
Buechel, Ronny R. ;
Nikolaou, Konstantin ;
Mickley, Hans ;
Yang, Lin ;
Zhang, Zhaqoi ;
Chen, Marcus Y. ;
Halon, David A. ;
Rief, Matthias ;
Sun, Kai ;
Hirt-Moch, Beatrice ;
Niinuma, Hiroyuki ;
Marcus, Roy P. ;
Muraglia, Simone ;
Jakamy, Reda ;
Chow, Benjamin J. ;
Kaufmann, Philipp A. ;
Tardif, Jean-Claude ;
Nomura, Cesar ;
Kofoed, Klaus F. .
BMJ-BRITISH MEDICAL JOURNAL, 2019, 365
[9]   Canadian Cardiovascular Society Guidelines for the Diagnosis and Management of Stable Ischemic Heart Disease [J].
Mancini, G. B. John ;
Gosselin, Gilbert ;
Chow, Benjamin ;
Kostuk, William ;
Stone, James ;
Yvorchuk, Kenneth J. ;
Abramson, Beth L. ;
Cartier, Raymond ;
Huckell, Victor ;
Tardif, Jean-Claude ;
Connelly, Kim ;
Ducas, John ;
Farkouh, Michael E. ;
Gupta, Milan ;
Juneau, Martin ;
O'Neill, Blair ;
Raggi, Paolo ;
Teo, Koon ;
Verma, Subodh ;
Zimmermann, Rodney .
CANADIAN JOURNAL OF CARDIOLOGY, 2014, 30 (08) :837-849
[10]   CT or Invasive Coronary Angiography in Stable Chest Pain [J].
Maurovich-Horvat, Pal ;
Bosserdt, Maria ;
Kofoed, Klaus F. ;
Rieckmann, Nina ;
Benedek, Theodora ;
Donnelly, Patrick ;
Rodriguez-Palomares, Jose ;
Erglis, Andrejs ;
Stechovsk, Cyril ;
Sakalyte, Gintare ;
Adic, Nada Cemerlic ;
Gutberlet, Matthias ;
Dodd, Jonathan D. ;
Diez, Ignacio ;
Davis, Gershan ;
Zimmermann, Elke ;
Kepka, Cezary ;
Vidakovic, Radosav ;
Francone, Marco ;
Ilnicka-Suckiel, Malgorzata ;
Plank, Fabian ;
Knuuti, Juhani ;
Faria, Rita ;
Schroder, Stephen ;
Berry, Colin ;
Saba, Luca ;
Ruzsics, Balazs ;
Kubiak, Christine ;
Gutierrez-Ibarluzea, Inaki ;
Hansen, Kristian Schultz ;
Muller-Nordhorn, Jacqueline ;
Merkely, Bela ;
Knudsen, Andreas D. ;
Benedek, Imre ;
Orr, Clare ;
Valente, Filipa Xavier ;
Zvaigzne, Ligita ;
Suchanek, Vojtech ;
Zajanckauskiene, Laura ;
Adic, Flip ;
Woinke, Michael ;
Hensey, Mark ;
Lecumberri, Inigo ;
Thwaite, Erica ;
Laule, Michael ;
Kruk, Mariusz ;
Neskovic, Aleksandar N. ;
Mancone, Massimo ;
Feuchtner, Gudrun ;
Kugrnierz, Donata .
NEW ENGLAND JOURNAL OF MEDICINE, 2022, 386 (17) :1591-1602