Borek Foldyna1, Johannes Uhlig2, Robin Gohmann3, Christian Lücke3, Thomas Mayrhofer4,5, Lukas Lehmkuhl6, Luigi Natale7, Rozemarijn Vliegenthart8, Joachim Lotz2, Rodrigo Salgado9,10, Marco Francone11, Christian Loewe12, Konstantin Nikolaou13, Fabian Bamberg14, David Maintz15, Pal Maurovich-Horvat16, Holger Thiele17, Udo Hoffmann4, Matthias Gutberlet3. 1. Cardiovascular Imaging Research Center, Massachusetts General Hospital - Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA. bfoldyna@mgh.harvard.edu. 2. Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Göttingen, Germany. 3. Department of Diagnostic and Interventional Radiology, Heart Center - University of Leipzig, Leipzig, Germany. 4. Cardiovascular Imaging Research Center, Massachusetts General Hospital - Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA. 5. School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany. 6. Clinic for Radiology, Rhoen-Klinikum AG, Campus Bad Neustadt, Bad Neustadt an der Saale, Germany. 7. Catholic University of the Sacred Heart, Rome, Italy. 8. Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. 9. Department of Radiology, Antwerp University Hospital, Antwerp, Belgium. 10. Department of Radiology, Holy Heart Hospital, Lier, Belgium. 11. Department of Biomedical Sciences, Humanitas University, Milan, Italy. 12. Division of Cardiovascular and Interventional Radiology, Department of Bioimaging, Medical University of Vienna, Vienna, Austria. 13. Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tübingen, Germany. 14. Department of Diagnostic and Interventional Radiology, Universitäts Klinikum Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany. 15. Department of Diagnostic and Interventional Radiology, University Medical Center Cologne, Cologne, Germany. 16. MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary. 17. Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
Abstract
OBJECTIVES: To compare the use of coronary computed tomography angiography (CCTA) between academic and non-academic sites across Europe over the last decade. METHODS: We analyzed a large multicenter registry (ESCR MR/CT Registry) of stable symptomatic patients who received CCTA 01/2010-01/2020 at 47 (22%) academic and 165 (78%) non-academic sites across 19 European countries. We compared image quality, radiation dose, contrast-media-related adverse events, patient characteristics, CCTA findings, and downstream testing between academic and non-academic sites. RESULTS: Among 64,317 included patients (41% female; 60 ± 13 years), academic sites accounted for most cases in 2010-2014 (52%), while non-academic sites dominated in 2015-2020 (71%). Despite less contemporary technology, non-academic sites maintained low radiation doses (4.76 [2.46-6.85] mSv) with a 30% decline of high-dose scans ( > 7 mSv) over time. Academic and non-academic sites both reported diagnostic image quality in 98% of cases and low rate of scan-related adverse events (0.4%). Academic and non-academic sites examined similar patient populations (41% females both; age: 61 ± 14 vs. 60 ± 12 years; pretest probability for obstructive CAD: low 21% vs. 23%, intermediate 73% vs. 72%, high 6% both, CAD prevalence on CCTA: 40% vs. 41%). Nevertheless, non-academic sites referred more patients to non-invasive ischemia testing (6.5% vs. 4.2%) and invasive coronary angiography/surgery (8.5% vs. 5.6%). CONCLUSIONS: Non-academic and academic sites provide safe, high-quality CCTA across Europe, essential to successfully implement the recently updated guidelines for the diagnosis and management of chronic coronary syndromes. However, despite examining similar populations with comparable CAD prevalence, non-academic sites tend to refer more patients to downstream testing. KEY POINTS: • Smaller non-academic providers increasingly use CCTA to rule out obstructive coronary artery disease. • Non-academic and academic sites provide comparably safe, high-quality CCTA across Europe. • Compared to academic sites, non-academic sites tend to refer more patients to downstream testing.
OBJECTIVES: To compare the use of coronary computed tomography angiography (CCTA) between academic and non-academic sites across Europe over the last decade. METHODS: We analyzed a large multicenter registry (ESCR MR/CT Registry) of stable symptomatic patients who received CCTA 01/2010-01/2020 at 47 (22%) academic and 165 (78%) non-academic sites across 19 European countries. We compared image quality, radiation dose, contrast-media-related adverse events, patient characteristics, CCTA findings, and downstream testing between academic and non-academic sites. RESULTS: Among 64,317 included patients (41% female; 60 ± 13 years), academic sites accounted for most cases in 2010-2014 (52%), while non-academic sites dominated in 2015-2020 (71%). Despite less contemporary technology, non-academic sites maintained low radiation doses (4.76 [2.46-6.85] mSv) with a 30% decline of high-dose scans ( > 7 mSv) over time. Academic and non-academic sites both reported diagnostic image quality in 98% of cases and low rate of scan-related adverse events (0.4%). Academic and non-academic sites examined similar patient populations (41% females both; age: 61 ± 14 vs. 60 ± 12 years; pretest probability for obstructive CAD: low 21% vs. 23%, intermediate 73% vs. 72%, high 6% both, CAD prevalence on CCTA: 40% vs. 41%). Nevertheless, non-academic sites referred more patients to non-invasive ischemia testing (6.5% vs. 4.2%) and invasive coronary angiography/surgery (8.5% vs. 5.6%). CONCLUSIONS: Non-academic and academic sites provide safe, high-quality CCTA across Europe, essential to successfully implement the recently updated guidelines for the diagnosis and management of chronic coronary syndromes. However, despite examining similar populations with comparable CAD prevalence, non-academic sites tend to refer more patients to downstream testing. KEY POINTS: • Smaller non-academic providers increasingly use CCTA to rule out obstructive coronary artery disease. • Non-academic and academic sites provide comparably safe, high-quality CCTA across Europe. • Compared to academic sites, non-academic sites tend to refer more patients to downstream testing.
Authors: Kevin K W Olesen; Anders H Riis; Lene H Nielsen; Flemming H Steffensen; Bjarne L Nørgaard; Jesper M Jensen; Per L Poulsen; Troels Thim; Hans Erik Bøtker; Henrik T Sørensen; Michael Maeng Journal: Eur Heart J Cardiovasc Imaging Date: 2019-11-01 Impact factor: 6.875
Authors: Thomas J Stocker; Simon Deseive; Jonathon Leipsic; Martin Hadamitzky; Marcus Y Chen; Ronen Rubinshtein; Mathias Heckner; Jeroen J Bax; Xiang-Ming Fang; Erik Lerkevang Grove; John Lesser; Pál Maurovich-Horvat; James Otton; Sanghoon Shin; Gianluca Pontone; Hugo Marques; Benjamin Chow; Cesar H Nomura; Ramzi Tabbalat; Axel Schmermund; Joon-Won Kang; Christopher Naoum; Melany Atkins; Eugenio Martuscelli; Steffen Massberg; Jörg Hausleiter Journal: Eur Heart J Date: 2018-11-01 Impact factor: 29.983
Authors: Stephan D Fihn; Julius M Gardin; Jonathan Abrams; Kathleen Berra; James C Blankenship; Apostolos P Dallas; Pamela S Douglas; Joanne M Foody; Thomas C Gerber; Alan L Hinderliter; Spencer B King; Paul D Kligfield; Harlan M Krumholz; Raymond Y K Kwong; Michael J Lim; Jane A Linderbaum; Michael J Mack; Mark A Munger; Richard L Prager; Joseph F Sabik; Leslee J Shaw; Joanna D Sikkema; Craig R Smith; Sidney C Smith; John A Spertus; Sankey V Williams Journal: J Am Coll Cardiol Date: 2012-11-19 Impact factor: 24.094
Authors: Michael T Lu; Pamela S Douglas; James E Udelson; Elizabeth Adami; Brian B Ghoshhajra; Michael H Picard; Rhonda Roberts; Kerry L Lee; Andrew J Einstein; Daniel B Mark; Eric J Velazquez; William Carter; Michael Ridner; Hussein R Al-Khalidi; Udo Hoffmann Journal: J Cardiovasc Comput Tomogr Date: 2017-08-15
Authors: Borek Foldyna; James E Udelson; Júlia Karády; Dahlia Banerji; Michael T Lu; Thomas Mayrhofer; Daniel O Bittner; Nandini M Meyersohn; Hamed Emami; Tessa S S Genders; Christopher B Fordyce; Maros Ferencik; Pamela S Douglas; Udo Hoffmann Journal: Eur Heart J Cardiovasc Imaging Date: 2019-05-01 Impact factor: 6.875
Authors: Mohamed Marwan; Stephan Achenbach; Grigorios Korosoglou; Axel Schmermund; Steffen Schneider; Oliver Bruder; Jörg Hausleiter; Stephen Schroeder; Sebastian Barth; Sebastian Kerber; Alexander Leber; Werner Moshage; Jochen Senges Journal: Int J Cardiovasc Imaging Date: 2017-12-01 Impact factor: 2.357
Authors: Jörg Hausleiter; Tanja Meyer; Franziska Hermann; Martin Hadamitzky; Markus Krebs; Thomas C Gerber; Cynthia McCollough; Stefan Martinoff; Adnan Kastrati; Albert Schömig; Stephan Achenbach Journal: JAMA Date: 2009-02-04 Impact factor: 56.272
Authors: Dimitri Buytaert; Benny Drieghe; Frédéric Van Heuverswyn; Jan De Pooter; Peter Gheeraert; Daniël De Wolf; Yves Taeymans; Klaus Bacher Journal: J Am Heart Assoc Date: 2020-07-01 Impact factor: 5.501