Article Abstract

Impact of non-invasive anatomical testing on optimal medical prescription in patients with suspected coronary artery disease

Authors: Stijn Devuyst, Arno Gigase, Jerrold Spapen, Sofie Brouwers, Thomas Couck, Jeroen Sonck, Takuya Mizukami, Carlo Gigante, Herbert de Raedt, Dan Schelfaut, Ward Heggermont, Bernard De Bruyne, Martin Penicka, Guy Van Camp, Carlos Collet


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.