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Nationwide Trends of Gatekeeper to Invasive Coronary Angiography in Suspected Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Real-world trends in the utility and type of gatekeeping studies in invasive coronary angiography (ICA) requires further investigation. METHODS: We identified outpatients who underwent noninvasive cardiac tests or directly ICA for suspected coronary artery disease (CAD) fr...

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Autores principales: Cha, Min Jae, Kim, William D, Won, Hoyoun, Joo, Jaeeun, Kim, Hasung, Kim, In-Cheol, Kim, Jin Young, Lee, Seonhwa, Cho, Iksung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Cardiology 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9643567/
https://www.ncbi.nlm.nih.gov/pubmed/36217588
http://dx.doi.org/10.4070/kcj.2022.0110
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author Cha, Min Jae
Kim, William D
Won, Hoyoun
Joo, Jaeeun
Kim, Hasung
Kim, In-Cheol
Kim, Jin Young
Lee, Seonhwa
Cho, Iksung
author_facet Cha, Min Jae
Kim, William D
Won, Hoyoun
Joo, Jaeeun
Kim, Hasung
Kim, In-Cheol
Kim, Jin Young
Lee, Seonhwa
Cho, Iksung
author_sort Cha, Min Jae
collection PubMed
description BACKGROUND AND OBJECTIVES: Real-world trends in the utility and type of gatekeeping studies in invasive coronary angiography (ICA) requires further investigation. METHODS: We identified outpatients who underwent noninvasive cardiac tests or directly ICA for suspected coronary artery disease (CAD) from the nationwide Korea Health Insurance Review and Assessment Service-National Patient Sample database between 2012 and 2018. RESULTS: Among 71,401 patients, the percentage of patients who were evaluated for suspected CAD was 34.7% for treadmill test (TMT), 4.2% for single-photon emission computed tomography (SPECT), 24.2% for coronary computed tomography angiography (CCTA), 1.6% for multiple gatekeepers, and 32.3% for directly ICA without noninvasive studies. The proportion of CCTA as a gatekeeper showed linear increase, (18.6% in 2012 and 28.8% in 2018; p<0.001), while those of TMT, SPECT, and direct ICA have decreased (p<0.001, p=0.03, and p<0.001, respectively). The overall incidence of downstream ICA after gatekeeper was 13.8% (6,662/48,346), and SPECT showed higher ICA rate in pairwise comparison with TMT and CCTA (p<0.001). Patients who performed gatekeepers before ICA showed higher rate of subsequent PCI (34.7% vs. 32.3%; p<0.001) and CABG (3.5% vs. 1.0%; p<0.001), compared to those who directly underwent ICA, and CCTA was associated with higher revascularization rate after ICA in pairwise comparison with TMT and SPECT (p<0.001). CONCLUSIONS: Nationwide database demonstrated that CCTA is utilized increasingly as a gatekeeper for ICA and is associated with high revascularization rate after ICA in outpatients with suspected CAD.
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spelling pubmed-96435672022-11-17 Nationwide Trends of Gatekeeper to Invasive Coronary Angiography in Suspected Coronary Artery Disease Cha, Min Jae Kim, William D Won, Hoyoun Joo, Jaeeun Kim, Hasung Kim, In-Cheol Kim, Jin Young Lee, Seonhwa Cho, Iksung Korean Circ J Original Research BACKGROUND AND OBJECTIVES: Real-world trends in the utility and type of gatekeeping studies in invasive coronary angiography (ICA) requires further investigation. METHODS: We identified outpatients who underwent noninvasive cardiac tests or directly ICA for suspected coronary artery disease (CAD) from the nationwide Korea Health Insurance Review and Assessment Service-National Patient Sample database between 2012 and 2018. RESULTS: Among 71,401 patients, the percentage of patients who were evaluated for suspected CAD was 34.7% for treadmill test (TMT), 4.2% for single-photon emission computed tomography (SPECT), 24.2% for coronary computed tomography angiography (CCTA), 1.6% for multiple gatekeepers, and 32.3% for directly ICA without noninvasive studies. The proportion of CCTA as a gatekeeper showed linear increase, (18.6% in 2012 and 28.8% in 2018; p<0.001), while those of TMT, SPECT, and direct ICA have decreased (p<0.001, p=0.03, and p<0.001, respectively). The overall incidence of downstream ICA after gatekeeper was 13.8% (6,662/48,346), and SPECT showed higher ICA rate in pairwise comparison with TMT and CCTA (p<0.001). Patients who performed gatekeepers before ICA showed higher rate of subsequent PCI (34.7% vs. 32.3%; p<0.001) and CABG (3.5% vs. 1.0%; p<0.001), compared to those who directly underwent ICA, and CCTA was associated with higher revascularization rate after ICA in pairwise comparison with TMT and SPECT (p<0.001). CONCLUSIONS: Nationwide database demonstrated that CCTA is utilized increasingly as a gatekeeper for ICA and is associated with high revascularization rate after ICA in outpatients with suspected CAD. The Korean Society of Cardiology 2022-09-15 /pmc/articles/PMC9643567/ /pubmed/36217588 http://dx.doi.org/10.4070/kcj.2022.0110 Text en Copyright © 2022. The Korean Society of Cardiology https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Cha, Min Jae
Kim, William D
Won, Hoyoun
Joo, Jaeeun
Kim, Hasung
Kim, In-Cheol
Kim, Jin Young
Lee, Seonhwa
Cho, Iksung
Nationwide Trends of Gatekeeper to Invasive Coronary Angiography in Suspected Coronary Artery Disease
title Nationwide Trends of Gatekeeper to Invasive Coronary Angiography in Suspected Coronary Artery Disease
title_full Nationwide Trends of Gatekeeper to Invasive Coronary Angiography in Suspected Coronary Artery Disease
title_fullStr Nationwide Trends of Gatekeeper to Invasive Coronary Angiography in Suspected Coronary Artery Disease
title_full_unstemmed Nationwide Trends of Gatekeeper to Invasive Coronary Angiography in Suspected Coronary Artery Disease
title_short Nationwide Trends of Gatekeeper to Invasive Coronary Angiography in Suspected Coronary Artery Disease
title_sort nationwide trends of gatekeeper to invasive coronary angiography in suspected coronary artery disease
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9643567/
https://www.ncbi.nlm.nih.gov/pubmed/36217588
http://dx.doi.org/10.4070/kcj.2022.0110
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