Author + information
- Eelin Wilsona,b,
- Kathy Heberta,b,
- Timothy Turcoa,b,
- Angela Johnsona,b,
- Jeff Hersha,b and
- Mount Sinai Westa,b
Background: Recent trials have demonstrated clinical benefits of coronary computed tomography angiography (CCTA) as a gateway to invasive coronary angiography (ICA) in suspected coronary artery disease (CAD). However, insufficient evidence exists to demonstrate clinical outperformance of CCTA vs. stress myocardial perfusion imaging (SMPI) as a gateway for downstream ICA.
Methods: A discrete event simulation (DES) model using sensitivity and specificity of tests, complication rates of diagnostic catheterizations and major adverse cardiac and cerebrovascular event (MACE), in an intermediate (40%) CAD prevalence model population compared pathways leading to ICA. False Score (FS), a composite rating of complication rates of missed diagnoses and diagnostic ICA, was used to compare the various pathways.
Results: CCTA-ICA exhibited lowest False Score (FS = 0.4 and 0.9 at 1 and 4 years, respectively). Notably, the difference in False Score among the pathways is magnified with time. CCTA-SMPI-ICA compared to SMPI-CCTA-ICA reduced overall diagnostic costs by −21.7% or $445,898 ($1.8 M vs. $2.3 M, respectively).
Conclusions: Using CCTA as an initial test reduces total diagnostics costs. The False Score suggests that CCTA as gateway to ICA would result in reduced catheterization complications and MACE at 1 and 4 years. The False Score also suggests that given a longer follow up period, the clinical outcomes of CCTA compared to other diagnostic tests would become statistically significant.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: Expanding Clinical Applications
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1161-233
- 2017 American College of Cardiology Foundation