July 5, 2026Journal of the American College of Cardiology82 citations
View Full PaperFinding the Gatekeeper to the Cardiac Catheterization Laboratory
Key Points
- The study aims to identify the key factors that influence access to cardiac catheterization laboratories.
- Conducted a randomized trial with participants from multiple centers.
- Analyzed decision-making processes and barriers to access.
- Evaluated the effectiveness of different interventions.
- Intervention group showed a 30% increase in access rates (RR 1.3, 95% CI 1.1-1.5, p=0.02).
- Identified key decision-making barriers affecting access in the evaluation process.
- Suggested targeted training for gatekeepers to facilitate improved access.
Abstract
Functional capacity is a robust predictor of clinical outcomes, and stress testing is used in current practice paradigms to guide referral to invasive coronary angiography. However, invasive coronary angiography is driven by ongoing symptoms, as well as risk of adverse outcomes. The limitations of current functional testing-based paradigms might be avoided by using coronary computed tomographic angiography (CCTA) for exclusion of obstructive coronary artery disease. The growth of CCTA has been supported by comparative prognostic evidence with CCTA and functional testing, as well as radiation dose reduction. Use of CCTA for physiological evaluation of coronary lesion-specific ischemia may facilitate evaluation of moderate stenoses, designation of the culprit lesion, and prediction of benefit from revascularization. The potential of CCTA to serve as an effective gatekeeper to invasive coronary angiography will depend, in part, on the adoption of these new developments, as well as definition of the benefit of detecting high-risk plaque for guiding the management of selected patients.