Computed tomography coronary angiography vs. standard diagnostic procedure for the diagnosis of angina due to coronary heart disease: A cross-sectional study

Patients with episodes of angina are likely to experience future cardiac events and benefit from a revascularization procedure. Conventional invasive coronary angiography is a well-established and reliable method for the detection of angina, but it has a risk of complications and false-negative diagnosis. The objective of the present study was to assess the utility of computed tomography coronary angiography (CTCA) in the diagnosis of angina due to coronary heart disease. A total of 2,426 patients with chest pain referred to the rapid access chest pain clinic of Beijing Anzhen Hospital, Capital Medical University (Beijing, P.R. China) between 18 January 2016 and 1 December 2017 were included in the present cross-sectional study. All patients were subjected to evaluation of symptoms, blood tests, 12-lead electrocardiogram (ECG), exercise ECG, coronary artery calcium scoring and CTCA. The cost of the diagnosis of angina was determined for each individual method. In total, 776 (32%) and 1,420 (58%) of patients were identified to be abnormal on clinical assessment and CTCA, respectively. Exercise ECG results were not correlated with the interpretation of CTCA (r=0.8511). The working area of the angina due to coronary heart disease detected at one time by the different diagnostic procedures was in the order of ECG <clinical assessment <exercise ECG <coronary artery calcium scoring <CTCA. The cost of the ‘standard diagnostic procedure (clinical assessments, ECG, exercise ECG)’ was 15,452±806 ¥/patient and that of CTCA was 12,546±612 ¥/patient. CTCA had a higher sensitivity for the diagnosis of angina due to coronary heart disease and the cost was lower than that of the ‘standard diagnostic procedure’ (level of evidence: 3). The current study was registered at the Research Registry on 11th January 2016 (trial no. researchregistry4232).