CT Coronary Angiography Versus Conventional Invasive Coronary Angiography – The View of the Referring Physician

Abstract

Purpose: Assessment of experience gained by local referring physicians with the procedure of coronary computed tomographic angiography (CCTA) in the everyday clinical routine.

Materials and Methods: A 25-item questionnaire was sent to 179 physicians, who together had referred a total of 1986 patients for CCTA. They were asked about their experience to date with CCTA, the indications for coronary imaging, and their practice in referring patients for noninvasive CCTA or invasive catheter angiography.

Results: 53 questionnaires (30 %) were assessable, corresponding to more than 72 % of the patients referred. Of the referring physicians who responded, 94 % saw a concrete advantage of CCTA in the treatment of patients, whereby 87 % were ‘satisfied’ or ‘very satisfied’ with the reporting. For excluding coronary heart disease (CHD) where there was a low pre-test probability of disease, the physicians considered CCTA to be superior to conventional coronary diagnosis (4.2 on a scale of 1 – 5) and vice versa for acute coronary syndrome (1.6 of 5). The main reasons for unsuitability of CCTA for CT diagnosis were claustrophobia and the absence of a sinus rhythm. The level of exposure to radiation in CCTA was estimated correctly by only 42 % of the referring physicians. 90 % of the physicians reported that their patients evaluated their coronary CT overall as ‘positive’ or ‘neutral’, while 87 % of the physicians whose patients had undergone both procedures reported that the patients had experienced CCTA as the less disagreeable of the two.

Conclusion: CCTA is accepted by the referring physicians as an alternative imaging procedure for the exclusion of CHD and received a predominantly positive assessment from both the referring physicians and the patients.

Key points:

• A high percentage of referring physicians had positive experiences with noninvasive CT coronary angiography (CCTA) so far.

• CCTA is accepted by referring physicians as an alternative imaging procedure for the exclusion of coronary heart disease.

• Noninvasive CT coronary angiography is perceived by patients in direct comparison with conventional invasive coronary angiography as less disagreeable.

Citation Format:

• Maurer MH, Zimmermann E, Hamm B et al. CT Coronary Angiography Versus Conventional Invasive Coronary Angiography – The View of the Referring Physician. Fortschr Röntgenstr 2014; 186: 1102 – 1110

Zusammenfassung

Zielsetzung: Evaluation der bisherigen Erfahrungen der lokalen Zuweiser mit dem Verfahren der Computertomografie (CT)-Koronarangiografie (CCTA) im praktischen Alltag.

Material und Methoden: Ein 25 Fragen umfassender Fragebogen wurde an 179 ärztliche Kollegen versandt, die bisher insgesamt 1986 Patienten für CT-Koronarangiografien überwiesen hatten. Gefragt wurde nach den bisherigen Erfahrungen mit CT-Koronarangiografien, der Indikationsstellung für eine Koronardiagnostik (z. B. Ausschluss einer koronaren Herzerkrankung ([KHK]) und der bisherigen Praxis bei der Überweisung für eine nicht-invasive CCTA oder eine invasive Katheterangiografie. Zusätzlich sollten beide diagnostischen Verfahren aus der Sicht der Überweiser und anhand der geschilderten Erfahrungen der Patienten beurteilt werden.

Ergebnisse: 53 Fragebogen konnten ausgewertet werden (30 % Auswerterate; entsprachen mehr als 72 % der überwiesenen Patienten). 94 % dieser Zuweiser sahen in der CT-Koronarangiografie einen konkreten Mehrwert in der Patientenbehandlung, wobei 87 % mit der Befunderstellung zufrieden oder sehr zufrieden waren. Auf einer 5-stufigen Skala hielten die Zuweiser zum Ausschluss einer KHK bei niedriger Prätestwahrscheinlichkeit die CT-Koronarangiografie (4,2/5) und die konventionelle Koronardiagnostik bei einem akuten Koronarsyndrom (1,6/5) als besser geeignet, beide Verfahren als etwa gleichwertig in der Verlaufskontrolle nach koronarem Bypass (3,0/5). Grund für eine Nichteignung für die CT-Diagnostik war vor allem eine berichtete Platzangst oder ein fehlender Sinusrhythmus. Die Höhe der Strahlenexposition für eine CCTA wurde von nur 42 % der Zuweiser richtig eingeschätzt. 90 % der Zuweiser berichteten, dass ihre Patienten die CT des Herzens insgesamt positiv oder neutral bewerteten, wobei 87 % der Zuweiser, deren Patienten bereits beide Verfahren erhalten hatten, aus Patientensicht von einer als weniger unangenehm empfundenen CCTA berichteten.

Schlussfolgerung: Die CT-Koronarangiografie stellt ein von den Zuweisern akzeptiertes bildgebendes Verfahren zum Ausschluss einer KHK dar, welches von den Zuweisern und Patienten überwiegend positiv bewertet wird.

Kernaussagen:

• Ein hoher Anteil der Zuweiser hat bisher gute Erfahrungen mit der nicht-invasiven CT-Koronarangiografie gemacht.

• Die CT-Koronarangiografie stellt ein von den Zuweisern akzeptiertes alternatives bildgebendes Verfahren zum Ausschluss einer koronaren Herzkrankheit dar.

• Die nicht-invasive CT-Koronarangiografie wird von Patienten im direkten Vergleich mit der invasiven konventionellen Koronarangiografie als weniger unangenehm empfunden.

Key words

cardiac - CT coronary angiography - survey - referring physician - patient satisfaction

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