CCTA to Optimize the Diagnostic Yield of Invasive Angiography

Hamilton Health Sciences Corporation186 enrolled

Overview

This study aims to reduce patient risk and costs to the healthcare system by improving the diagnostic yield of invasive coronary angiography through existing triage processes to improve risk stratification using Coronary Computed Tomographic Angiography (CCTA) as a first step in low risk patients. All low-risk patients referred for invasive coronary angiography will be potentially eligible for CCTA instead of invasive angiography as a first-line diagnostic test. All CCTAs will be read by both a level 3-trained cardiologist and a radiologist. The results of the CCTA, coupled with evidence-based management recommendations will be sent to the referring physician and an invasive angiogram will be arranged by the HIU triage, only when clearly indicated

Study Type

OBSERVATIONAL

Enrollment

186

Conditions

Coronary Artery Disease

Interventions

Coronary Computed Tomographic AngiographyDIAGNOSTIC_TEST

All low-risk patients referred for invasive coronary angiography will be potentially eligible to receive the intervention over a 12-month period. The intervention will include risk stratification using Coronary Computed Tomographic Angiography (CCTA) at HHS and NHS as an alternative to upfront invasive angiography. All CCTAs will be read by both a level 3-trained cardiologist and a radiologist. The results of the CCTA, coupled with evidence-based management recommendations will be sent to the referring physician and an invasive angiogram will be arranged only when indicated as per these management recommendations

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Non urgent outpatient referral 2. Canadian Cardiovascular Society class I or II 3. Indication for invasive angiogram includes: Rule out Coronary Artery Disease (CAD) and Cardiomyopathy Exclusion Criteria: 1. Age \<18 years old, Men \>65 years old or women \>75 years old 2. Patient refusal to provide verbal consent for CCTA at time of triage contact or unable to provide informed consent 3. Referring physician refusal for their eligible patients to be approached for the CarDIA study 4. Any prior CCTA 5. Atrial Fibrillation 6. Creatinine \> 150 mmol/L 7. Diabetes mellitus 8. High risk Exercise Stress Test or Functional Imaging 9. Known severe valvular disease being considered for valve surgery 10. Any known CAD * Prior Acute Coronary Syndrome (ACS) * Prior Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft (CABG)

Outcomes

Primary Outcomes

Diagnostic yield of invasive angiography

Diagnostic yield is defined as the proportion of invasive angiograms that identify significant disease (≥70% stenosis) on a major coronary vessel (\>2 mm) or \> 50% stenosis in the left main)

Time frame: Three years

Secondary Outcomes

Quantitative assessment of angiograms avoided

Number of angiograms avoided due to CCTA bookings

Time frame: Three years

Deviation from management recommendations following CCTA

Number of angiograms performed when not recommended

Time frame: Three years

Protocol deviation as a surrogate for acceptability of the novel triage program

Percentage of patients and physicians refusing to undergo CCTA as a first step

Time frame: Three years

Costing of new strategy

Cost of risk stratification of Coronary Artery Disease in low risk patients

Time frame: Three years

CCTA to Optimize the Diagnostic Yield of Invasive Angiography

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes