PDF(Pubmed)
Abstract：
Coronary computed tomography angiography is increasingly used as the first-line test for suspected coronary artery disease. Its overuse in a low pretest probability (PTP) population may lead to low diagnostic yield without change in patient management. We evaluated the clinical consequences of the updated 2019 European Society of Cardiology (ESC) chronic coronary syndromes guidelines\' PTP estimation and whether imaging could be safely deferred in patients with a low PTP.
This retrospective cohort included all 1753 consecutive patients who underwent coronary computed tomography angiography for suspected coronary artery disease at Helsinki University Hospital between 2009 and 2017. PTP was calculated according to the 2013 and 2019 ESC guidelines. The overall mortality, cardiac deaths, myocardial infarctions, and hospitalizations for unstable angina were acquired from national registry data for 1 to 10 years of follow-up (median, 4 years). Updated 2019 ESC guidelines classified 72% of the patients as having low PTP, whose imaging could have been deferred. The revascularization rate (4.7%) and annual cardiac mortality (0.4%) were low in the 857 patients reclassified from the recommendation to test, according to the 2013 ESC guideline, to deferral of coronary computed tomography angiography, according to the new 2019 guideline.
The updated 2019 ESC guideline PTP score aids clinicians in safely preventing the overuse of cardiac imaging in patients deemed at low PTP of coronary artery disease. Diagnostic yield, revascularization rate, and cardiac mortality are low in patients with low pretest risk.
This retrospective cohort included all 1753 consecutive patients who underwent coronary computed tomography angiography for suspected coronary artery disease at Helsinki University Hospital between 2009 and 2017. PTP was calculated according to the 2013 and 2019 ESC guidelines. The overall mortality, cardiac deaths, myocardial infarctions, and hospitalizations for unstable angina were acquired from national registry data for 1 to 10 years of follow-up (median, 4 years). Updated 2019 ESC guidelines classified 72% of the patients as having low PTP, whose imaging could have been deferred. The revascularization rate (4.7%) and annual cardiac mortality (0.4%) were low in the 857 patients reclassified from the recommendation to test, according to the 2013 ESC guideline, to deferral of coronary computed tomography angiography, according to the new 2019 guideline.
The updated 2019 ESC guideline PTP score aids clinicians in safely preventing the overuse of cardiac imaging in patients deemed at low PTP of coronary artery disease. Diagnostic yield, revascularization rate, and cardiac mortality are low in patients with low pretest risk.
摘要：
背景：冠状动脉计算机断层扫描血管造影越来越多地用作可疑冠状动脉疾病的一线检查。在低预测试概率（PTP）人群中过度使用可能会导致低诊断率，而不会改变患者管理。我们评估了更新的2019年欧洲心脏病学会（ESC）慢性冠状动脉综合征指南的临床后果，并评估了低PTP患者的影像学检查是否可以安全地推迟。
结果：该回顾性队列包括2009年至2017年在赫尔辛基大学医院接受冠状动脉CT血管造影检查的所有1753名连续患者。PTP是根据2013年和2019年ESC指南计算的。总死亡率，心脏死亡,心肌梗塞,和不稳定型心绞痛的住院治疗从国家注册数据获得1到10年的随访(中位数，4年）。2019年更新的ESC指南将72%的患者分类为低PTP，他们的成像可能会被推迟。从推荐到测试重新分类的857例患者的血运重建率（4.7％）和年心源性死亡率（0.4％）较低。根据2013年ESC指南，推迟冠状动脉计算机断层扫描血管造影，根据2019年新指南。
结论：更新的2019年ESC指南PTP评分有助于临床医生安全地防止被认为冠状动脉疾病PTP低的患者过度使用心脏成像。诊断产量,血运重建率,低测试前风险患者的心脏死亡率较低。
结果：该回顾性队列包括2009年至2017年在赫尔辛基大学医院接受冠状动脉CT血管造影检查的所有1753名连续患者。PTP是根据2013年和2019年ESC指南计算的。总死亡率，心脏死亡,心肌梗塞,和不稳定型心绞痛的住院治疗从国家注册数据获得1到10年的随访(中位数，4年）。2019年更新的ESC指南将72%的患者分类为低PTP，他们的成像可能会被推迟。从推荐到测试重新分类的857例患者的血运重建率（4.7％）和年心源性死亡率（0.4％）较低。根据2013年ESC指南，推迟冠状动脉计算机断层扫描血管造影，根据2019年新指南。
结论：更新的2019年ESC指南PTP评分有助于临床医生安全地防止被认为冠状动脉疾病PTP低的患者过度使用心脏成像。诊断产量,血运重建率,低测试前风险患者的心脏死亡率较低。
