BACKGROUND: Compared to functional testing, coronary computed tomography angiography (CTA) improves clinical outcomes in patients with suspected coronary artery disease (CAD). This is thought to be the result of an increased prescription of preventive medical therapy (statins and aspirin) when relying on a CTA imaging strategy. We compared the rate of statins prescription in a patient cohort assessed either with coronary CTA or exercise testing, and evaluated the agreement on medication prescriptions. METHODS: Consecutive patients who underwent coronary CTA and exercise test for suspected CAD were included. Four clinical cardiologists independently analysed each case based on clinical information and the result of either coronary CTA or exercise test. For each case, treatment strategy and prescription were recorded while blinded to the results of the other cardiac test. Treatment strategy was reassessed using the alternative imaging modality three weeks after the first evaluation. RESULTS: A total of 113 patients were included. Mean age was 56.7±11.5 years, 52% were males and diabetes were present in 6%. Coronary CTA showed an obstructive epicardial stenosis in 21.4% and any type of atherosclerotic plaque in 54.2%. Functional testing identified ischemia in 9.1%. The use of coronary CTA resulted in higher number of statin (64.9% vs. 44.5%, P<0.001) and aspirin (21.4% vs. 4.3%, P<0.001) prescriptions. There was a substantial agreement on the prescription of statins (mean Cohen's κ coefficient of 0.79±0.07). CONCLUSIONS: Epicardial atherosclerotic disease was found in half of patients with suspected CAD as assessed by coronary CTA. Compared to functional testing, coronary CTA evaluation by coronary was associated with an increase in the rate preventive therapy prescription.
BACKGROUND: Compared to functional testing, coronary computed tomography angiography (CTA) improves clinical outcomes in patients with suspected coronary artery disease (CAD). This is thought to be the result of an increased prescription of preventive medical therapy (statins and aspirin) when relying on a CTA imaging strategy. We compared the rate of statins prescription in a patient cohort assessed either with coronary CTA or exercise testing, and evaluated the agreement on medication prescriptions. METHODS: Consecutive patients who underwent coronary CTA and exercise test for suspected CAD were included. Four clinical cardiologists independently analysed each case based on clinical information and the result of either coronary CTA or exercise test. For each case, treatment strategy and prescription were recorded while blinded to the results of the other cardiac test. Treatment strategy was reassessed using the alternative imaging modality three weeks after the first evaluation. RESULTS: A total of 113 patients were included. Mean age was 56.7±11.5 years, 52% were males and diabetes were present in 6%. Coronary CTA showed an obstructive epicardial stenosis in 21.4% and any type of atherosclerotic plaque in 54.2%. Functional testing identified ischemia in 9.1%. The use of coronary CTA resulted in higher number of statin (64.9% vs. 44.5%, P<0.001) and aspirin (21.4% vs. 4.3%, P<0.001) prescriptions. There was a substantial agreement on the prescription of statins (mean Cohen's κ coefficient of 0.79±0.07). CONCLUSIONS: Epicardial atherosclerotic disease was found in half of patients with suspected CAD as assessed by coronary CTA. Compared to functional testing, coronary CTA evaluation by coronary was associated with an increase in the rate preventive therapy prescription.
Authors: Gilles Montalescot; Udo Sechtem; Stephan Achenbach; Felicita Andreotti; Chris Arden; Andrzej Budaj; Raffaele Bugiardini; Filippo Crea; Thomas Cuisset; Carlo Di Mario; J Rafael Ferreira; Bernard J Gersh; Anselm K Gitt; Jean-Sebastien Hulot; Nikolaus Marx; Lionel H Opie; Matthias Pfisterer; Eva Prescott; Frank Ruschitzka; Manel Sabaté; Roxy Senior; David Paul Taggart; Ernst E van der Wall; Christiaan J M Vrints; Jose Luis Zamorano; Stephan Achenbach; Helmut Baumgartner; Jeroen J Bax; Héctor Bueno; Veronica Dean; Christi Deaton; Cetin Erol; Robert Fagard; Roberto Ferrari; David Hasdai; Arno W Hoes; Paulus Kirchhof; Juhani Knuuti; Philippe Kolh; Patrizio Lancellotti; Ales Linhart; Petros Nihoyannopoulos; Massimo F Piepoli; Piotr Ponikowski; Per Anton Sirnes; Juan Luis Tamargo; Michal Tendera; Adam Torbicki; William Wijns; Stephan Windecker; Juhani Knuuti; Marco Valgimigli; Héctor Bueno; Marc J Claeys; Norbert Donner-Banzhoff; Cetin Erol; Herbert Frank; Christian Funck-Brentano; Oliver Gaemperli; José R Gonzalez-Juanatey; Michalis Hamilos; David Hasdai; Steen Husted; Stefan K James; Kari Kervinen; Philippe Kolh; Steen Dalby Kristensen; Patrizio Lancellotti; Aldo Pietro Maggioni; Massimo F Piepoli; Axel R Pries; Francesco Romeo; Lars Rydén; Maarten L Simoons; Per Anton Sirnes; Ph Gabriel Steg; Adam Timmis; William Wijns; Stephan Windecker; Aylin Yildirir; Jose Luis Zamorano Journal: Eur Heart J Date: 2013-08-30 Impact factor: 29.983
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Authors: Pamela S Douglas; Udo Hoffmann; Manesh R Patel; Daniel B Mark; Hussein R Al-Khalidi; Brendan Cavanaugh; Jason Cole; Rowena J Dolor; Christopher B Fordyce; Megan Huang; Muhammad Akram Khan; Andrzej S Kosinski; Mitchell W Krucoff; Vinay Malhotra; Michael H Picard; James E Udelson; Eric J Velazquez; Eric Yow; Lawton S Cooper; Kerry L Lee Journal: N Engl J Med Date: 2015-03-14 Impact factor: 91.245
Authors: Pamela S Douglas; Gianluca Pontone; Mark A Hlatky; Manesh R Patel; Bjarne L Norgaard; Robert A Byrne; Nick Curzen; Ian Purcell; Matthias Gutberlet; Gilles Rioufol; Ulrich Hink; Herwig Walter Schuchlenz; Gudrun Feuchtner; Martine Gilard; Daniele Andreini; Jesper M Jensen; Martin Hadamitzky; Karen Chiswell; Derek Cyr; Alan Wilk; Furong Wang; Campbell Rogers; Bernard De Bruyne Journal: Eur Heart J Date: 2015-09-01 Impact factor: 29.983