EACVI survey on investigations and imaging modalities in chronic coronary syndromes.

Abstract

AIMS:

The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate current practice for the assessment and management of patients with suspected and confirmed chronic coronary syndromes.

METHODS AND RESULTS:

One-hundred and ten imaging centres from 37 countries across the world responded to the survey. Most non-invasive investigations for coronary artery disease were widely available, except cardiovascular magnetic resonance (available 40% centres). Coronary computed tomography angiography (CCTA) and nuclear scans were reported by a multi-disciplinary team in only a quarter of centres. In the initial assessment of patients presenting with chest pain, only 32% of respondents indicated that they rely on pre-test probability for selecting the optimal imaging test while 31% proceed directly to CCTA. In patients with established coronary artery disease and recurrent chest pain, respondents opted for stress echocardiography (27%) and nuclear stress perfusion scans (26%). In asymptomatic patients with coronary artery disease and an obstructive (>70%) right coronary artery stenosis, 58% of respondents were happy to pursue medical therapy without further testing or intervention. This proportion fell to 29% with left anterior descending artery stenosis and 1% with left main stem obstruction. In asymptomatic patients with evidence of moderate-to-severe myocardial ischaemia (15%), only 18% of respondents would continue medical therapy without further investigation.

CONCLUSION:

Despite guidelines recommendations pre-test probability is used to assess patients with suspected coronary artery in a minority of centres, one-third of centres moving directly to CCTA. Clinicians remain reticent to pursue a strategy of optimal medical therapy without further investigation or intervention in patients with controlled symptoms but obstructive coronary artery stenoses or myocardial ischaemia.

• Authors: Anda Bularga, Antti Saraste, Ricardo Fontes-Carvalho, Espen Holte, Matteo Cameli, Blazej Michalski, Michelle C Williams, Tomaz Podlesnikar, Antonello D'Andrea, Ivan Stankovic, Nicholas L Mills, Robert Manka, David E Newby, Jeanette Schultz-Menger, Kristina H Haugaa, Marc R Dweck
• Journal: European heart journal. Cardiovascular Imaging (Eur Heart J Cardiovasc Imaging) Vol. 22 Issue 1 Pg. 1-7 (01 01 2021) ISSN: 2047-2412 [Electronic] England
• PMID: 33165600 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

Topics

• Coronary Angiography
• Coronary Artery Disease (diagnostic imaging)
• Humans
• Myocardial Perfusion Imaging
• Surveys and Questionnaires
• Syndrome