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Appropriate Use Criteria (AUC) for cardiac computed tomography angiography (CCTA) was updated in 2010, however data on its impact on downstream cardiac testing, treatment, and clinical outcomes is limited.
Retrospective analysis of all CCTA performed at a single center from 2010-2011. Studies were rated with CCTA AUC and its impact in downstream additional cardiac testing and revascularization were assessed at 90-days and 12-months. Coronary artery disease (CAD) diagnosis and changes in medical therapy was also assessed based on AUC.
458 patients were reviewed using AUC for CCTA. 402 (87.8%) of the studies were appropriate(AP), 37 (8.1%) were inappropriate(IP), and 29 (4.2%) were uncertain category. The most common AP indication was a prior equivocal/discordant stress test results (AUC #23 subgroup) accounting for 35% of appropriate studies, and the most common IP indication was a moderate to severely abnormal stress test (AUC #23 subgroup) accounting also for 35% of the studies. There was no difference between AP and IP groups in additional cardiac testing at 90-days (5.0% vs. 11%, p=0.135) and 12-months (13% vs. 22%, p=0.164), although a trend was observed with lesser testing in the AP group at both time points. Marginal significance was found for greater CAD detection in the IP group likely secondary to more abnormal stress tests prior to the CCTA (31% vs. 46%, p=0.0598). Revascularization (5.0% vs. 8.8%, p=0.344), or non-cardiac diagnosis (13% vs. 8%, p=0.425) was not different between AP and IP groups. However, once CAD was diagnosed there was higher rate of changes in medical therapy than when not (52% vs. 5%, p<0.0001). No difference was seen when CCTA was ordered by a cardiologist or non-cardiologist (p=0.372).
Our study highlights a high rate of appropriate CCTA overall at our institution. No major impact was noted on downstream resource utilization based on AUC categorized CCTA. However AUC identified some gaps in practice patterns warranting improvement particularly in inappropriate CCTA use when stress tests are very abnormal. ACC/AHA AUC criteria may help institutions reflect on their patterns of test utilization and should be widely adopted.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Imaging: CT/Multimodality IV
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1182-353
- 2013 American College of Cardiology Foundation