The introduction of Photon Counting CT and increased functional assessment during invasive coronary angiography reduced potential inappropriate revascularization from 16% to 12%.
Observational (n=2,197)
No
Does the introduction of Photon Counting CT (PCCT) improve diagnostic and therapeutic appropriateness in patients with suspected stable ischemic heart disease undergoing elective invasive coronary angiography?
The adoption of Photon Counting CT (PCCT) in a specialized cardiovascular center improved pre-procedural risk stratification, leading to more appropriate invasive coronary angiography and reduced inappropriate revascularizations.
Absolute Event Rate: 12% vs 16%
Abstract Background According to ESC guidelines, functional and/or anatomical non-invasive imaging tests are recommended for management of stable ischemic heart disease (SIHD), being invasive coronary angiography (ICA) indicated just in case of inconclusive non-invasive testing and/or of strong indication to coronary revascularization. Availability of various tools can strongly change the level of appropriateness in diagnosis and treatment, even in a very specialistic setting. Purpose Analysis of specialists’ behaviour in a focus hospital for cardiovascular diseases, fully equipped for the diagnosis and treatment of patients with SIHD, with a special focus on appropriateness and possible behaviour modifications after Photon Counting CT (PCCT) acquisition. Methods A retrospective analysis of pts undergoing elective ICA from 2022 to 2024 was conducted using hospital management software, with a specific focus on tests performed in the 12 months before. Exclusion criteria were:acute coronary syndromes or elective cardiac surgery (no CABG) or structural heart interventions. Annual trends in non-invasive imaging tests, appropriate indication to ICA and revascularization rates were evaluated. Results Between 2022 and 2024, 2,197 pts with suspected SIHD (81,4% males; mean age 70,9±9,3yrs) underwent ICA. Overall, 1,451 pts (66%) had a significant CAD with indication to revascularization (PCI or CABG): this percentage was stable through the 3 years. Nearly all pts (82%) undergoing ICA were evaluated with at least one non-invasive test; a small subgroup of pts (18%) underwent ICA taking into risk stratification performed at other hospitals. In this subgroup, the percentage of pts with no indication of revascularization was similar to the overall population (nearly 34%) (Fig.1). Following PCCT introduction an increase in CCTA utilization was observed: this was mirrored by a drop in nuclear medicine tests and other imaging tests (Fig.2). It was also mirrored by a progressive increase in functional assessment of epicardial stenosis severity with a more appropriate subsequent revascularization (from 12% to 22%), reducing potential inappropriate revascularization (from 16% to 12%). Conclusion In a cardiological environment, adoption of advanced imaging technologies reflects a progressive shift toward a more precision management of SIHD, with a higher rate of ICA followed by revascularization vs european benchmark. Revascularization rates suggest procedural appropriateness, supported by tools availability and integration. Improved PPV of PCCT, together with increasing use of functional assessment during ICA, helped in limiting test redundancy and possible inappropriate revascularization. PCCT CT likely contributed to refine pre-procedural risk stratification, resulting in improved appropriateness at ICA, even in a population of very specialized physicians, already equipped with all tools.Fig.1 Fig.2
Baroni et al. (Thu,) conducted a observational in Stable ischemic heart disease (SIHD) (n=2,197). Photon Counting CT (PCCT) vs. Prior imaging strategies was evaluated on Potential inappropriate revascularization. The introduction of Photon Counting CT and increased functional assessment during invasive coronary angiography reduced potential inappropriate revascularization from 16% to 12%.