Abstract
Purpose: Cardiac imaging expenditures have come under scrutiny, and a focus on appropriate use criteria (AUC) has arisen to ensure cost-effective resource utilization. Although AUC has been developed by clinical experts, it has not undergone rigorous quality assurance testing to ensure that inappropriate indications for testing yield little clinical benefit. The objective of the study was to evaluate the potential incremental prognostic value of coronary computed tomographic angiography (CCTA) in the different AUC categories. Materials and Methods: Consecutive patients enrolled into a cardiac CT Registry were collated. Patient indications were reviewed and based on the 2010 AUC (appropriate, uncertain, and inappropriate). Patients were followed-up for death, myocardial infarction (MI), and late revascularization, with the primary composite endpoint being cardiac death, nonfatal MI, and late revascularization. The prognostic value of CCTA over clinical variables in each of the AUC categories was assessed. Results: Indications for CCTA were appropriate, uncertain, and inappropriate in 1284 (66.5%), 312 (16.2%), and 334 (17.3%) patients, respectively. Rates of all-cause of death, cardiac death, nonfatal MI, and late revascularization were similar across patients with appropriate, uncertain, and inappropriate indications for CCTA. Moreover, in each AUC category, CCTA had incremental prognostic value over a routine clinical risk score (National Cholesterol Education Program) with hazard ratios of 9.98, 7.39, and 5.61. Conclusions: CCTA has incremental prognostic value in all AUC categories, even when the reason for the study was deemed "inappropriate." This suggests that CCTA may still have clinical value in "inappropriate" indications and that further quality assurance AUC studies are needed.
| Original language | English |
|---|---|
| Pages (from-to) | 132-137 |
| Number of pages | 6 |
| Journal | Journal of Thoracic Imaging |
| Volume | 33 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 1 Jan 2018 |
| Externally published | Yes |
Keywords
- appropriate use criteria
- cardiac computed tomography
- prognosis
Cite this
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Appropriate Use Criteria for Cardiac Computed Tomography : Does Computed Tomography Have Incremental Value in All Appropriate Use Criteria Categories? / Erthal, Fernanda; Premaratne, Manuja; Yam, Yeung; Chen, Li; Lamba, Jasmine; Keenan, Marissa; Haddad, Tony; Pharasi, Kishu; Anand, Saipriya; Beanlands, Rob S.; Burwash, Ian G.; Dwivedi, Girish; Ruddy, Terrence D.; Chow, Benjamin J.W.
In: Journal of Thoracic Imaging, Vol. 33, No. 2, 01.01.2018, p. 132-137.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Appropriate Use Criteria for Cardiac Computed Tomography
T2 - Does Computed Tomography Have Incremental Value in All Appropriate Use Criteria Categories?
AU - Erthal, Fernanda
AU - Premaratne, Manuja
AU - Yam, Yeung
AU - Chen, Li
AU - Lamba, Jasmine
AU - Keenan, Marissa
AU - Haddad, Tony
AU - Pharasi, Kishu
AU - Anand, Saipriya
AU - Beanlands, Rob S.
AU - Burwash, Ian G.
AU - Dwivedi, Girish
AU - Ruddy, Terrence D.
AU - Chow, Benjamin J.W.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Purpose: Cardiac imaging expenditures have come under scrutiny, and a focus on appropriate use criteria (AUC) has arisen to ensure cost-effective resource utilization. Although AUC has been developed by clinical experts, it has not undergone rigorous quality assurance testing to ensure that inappropriate indications for testing yield little clinical benefit. The objective of the study was to evaluate the potential incremental prognostic value of coronary computed tomographic angiography (CCTA) in the different AUC categories. Materials and Methods: Consecutive patients enrolled into a cardiac CT Registry were collated. Patient indications were reviewed and based on the 2010 AUC (appropriate, uncertain, and inappropriate). Patients were followed-up for death, myocardial infarction (MI), and late revascularization, with the primary composite endpoint being cardiac death, nonfatal MI, and late revascularization. The prognostic value of CCTA over clinical variables in each of the AUC categories was assessed. Results: Indications for CCTA were appropriate, uncertain, and inappropriate in 1284 (66.5%), 312 (16.2%), and 334 (17.3%) patients, respectively. Rates of all-cause of death, cardiac death, nonfatal MI, and late revascularization were similar across patients with appropriate, uncertain, and inappropriate indications for CCTA. Moreover, in each AUC category, CCTA had incremental prognostic value over a routine clinical risk score (National Cholesterol Education Program) with hazard ratios of 9.98, 7.39, and 5.61. Conclusions: CCTA has incremental prognostic value in all AUC categories, even when the reason for the study was deemed "inappropriate." This suggests that CCTA may still have clinical value in "inappropriate" indications and that further quality assurance AUC studies are needed.
AB - Purpose: Cardiac imaging expenditures have come under scrutiny, and a focus on appropriate use criteria (AUC) has arisen to ensure cost-effective resource utilization. Although AUC has been developed by clinical experts, it has not undergone rigorous quality assurance testing to ensure that inappropriate indications for testing yield little clinical benefit. The objective of the study was to evaluate the potential incremental prognostic value of coronary computed tomographic angiography (CCTA) in the different AUC categories. Materials and Methods: Consecutive patients enrolled into a cardiac CT Registry were collated. Patient indications were reviewed and based on the 2010 AUC (appropriate, uncertain, and inappropriate). Patients were followed-up for death, myocardial infarction (MI), and late revascularization, with the primary composite endpoint being cardiac death, nonfatal MI, and late revascularization. The prognostic value of CCTA over clinical variables in each of the AUC categories was assessed. Results: Indications for CCTA were appropriate, uncertain, and inappropriate in 1284 (66.5%), 312 (16.2%), and 334 (17.3%) patients, respectively. Rates of all-cause of death, cardiac death, nonfatal MI, and late revascularization were similar across patients with appropriate, uncertain, and inappropriate indications for CCTA. Moreover, in each AUC category, CCTA had incremental prognostic value over a routine clinical risk score (National Cholesterol Education Program) with hazard ratios of 9.98, 7.39, and 5.61. Conclusions: CCTA has incremental prognostic value in all AUC categories, even when the reason for the study was deemed "inappropriate." This suggests that CCTA may still have clinical value in "inappropriate" indications and that further quality assurance AUC studies are needed.
KW - appropriate use criteria
KW - cardiac computed tomography
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=85044099416&partnerID=8YFLogxK
U2 - 10.1097/RTI.0000000000000297
DO - 10.1097/RTI.0000000000000297
M3 - Article
VL - 33
SP - 132
EP - 137
JO - Journal of Thoracic Imaging
JF - Journal of Thoracic Imaging
SN - 0883-5993
IS - 2
ER -