The study findings, published in JACC: Cardiovascular Imaging, indicate that CCTA is an effective alternative to other modes of CAD assessment, such as invasive coronary angiography.

In 2016, the NICE (National Institute for Health and Care Excellence) recommended coronary computed tomography angiography as the first-line test for possible angina (CG95). Jonathan R.Weir-McCall, Royal Papworth Hospital, Cambridge, United Kingdom, and colleagues aimed to determine the effect of temporal trends in imaging use on coronary artery disease outcomes following the CG95 recommendations.

An interrupted time-series analysis was used to assess the impact of CG95. For this purpose, the researchers extracted investigations from 2012 to 2018 from a national database and linked-hospital admission and mortality registries. Adjustments to growth rates were made for population size, cardiovascular hospital admissions, image modality use, and mortality compared using Kendall’s rank correlation.

The study revealed the following findings:

• One million nine hundred nine thousand three hundred fourteen investigations were performed for CAD, with an annualized per capita growth of 4.8%.
• Costs were £0.35 million/100,000 population/year with a rise of 2.8%/year mirroring inflation (2.5%/year).
• CG95 was associated with an increase in CCTA (exp[β]: 1.10), no change in myocardial perfusion imaging, and a potential modest fall (exp[β]: 0.997) in invasive coronary angiography.
• There was an apparent trend between computed tomography angiography growth and reduction in invasive catheter angiography across regions (Kendall Tau: −0.19).
• CCTA growth was associated with a reduction in cardiovascular mortality (Kendall Tau: −0.21) and ischemic heart disease deaths (Kendall Tau: −0.22), with an apparent trend with reduced all-cause mortality (Kendall Tau: −0.19).

“Imaging investigations for CAD are increasing,” researchers wrote. “Greater regional increases in CCTA were associated with a more rapid decline in CAD mortality and fewer hospitalizations for myocardial infarction.”

Reference:

Weir-McCall, J. R., Williams, M. C., Shah, A. S., Roditi, G., Rudd, J. H., Newby, D. E., & Nicol, E. D. (2023). National Trends in Coronary Artery Disease Imaging: Associations With Health Care Outcomes and Costs. JACC: Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2022.10.022