Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

• Published in: Postępy w kardiologii interwencyjnej Vol. 14; no. 3; pp. 247 - 257
• Main Authors: Chmiel, Jakub, Książek, Miłosz K., Stryszak, Weronika, Iwaszczuk, Paweł, Hołda, Mateusz K., Świtacz, Grażyna, Kozanecki, Artur, Wilkołek, Piotr, Rubiś, Paweł, Kopeć, Grzegorz, Odrowąż-Pieniążek, Piotr, Przewłocki, Tadeusz, Tracz, Wiesława, Podolec, Piotr, Musiałek, Piotr
• Format: Journal Article
• Language: English
• Published: Poznan Termedia Publishing House 01-09-2018
• Subjects: angiography; Atherosclerosis; Cardiovascular disease; coronary angiogram; coronary angiography; coronary artery disease; Coronary vessels; diagnosis; invasive evaluation; Medical imaging
• ISSN: 1734-9338; 1897-4295
• DOI: 10.5114/aic.2018.78327

Introduction Invasive coronary angiography (CAG), the ‘gold standard’ in coronary artery disease (CAD) diagnosis, requires hospitalization, is not risk-free, and engages considerable healthcare resources. Aim To assess recent (throught out 10 years) evolution of ‘significant’ (≥ 50% stenosis(es)) CAD prevalence in subjects undergoing CAG for CAD diagnosis in a high-volume tertiary referral center. Material and methods Anonymized medical records were compared from the last vs. the first 2-years of the decade (June 2007 to May 2018). Referrals for suspected CAD were 2067 of 4522 hospitalizations (45.7%) and 1755 of 5196 (33.8%) respectively (p < 0.001). Results The median patient age (64 vs. 68 years) and the prevalence of heart failure (24.1% vs. 42.2%) increased significantly (p < 0.001). The CAG atherosclerotic lesions, for all stenosis categories (< 50%; ≥ 50%; ≥ 70%; occlusion(s)), were significantly more prevalent in men. The proportion of subjects with any atherosclerosis on CAG increased (80.7% vs. 77.6%, p = 0.015). However, in the absence of any gross change in, for instance, the fraction of women (40.4% vs. 41.8%), the proportion of CAGs with significant CAD (lesion(s) ≥ 50%) decreased from 55.2% in 2007/2008 to below 1 in every 2 angiograms (48.9%) in 2017/2018 (p < 0.001). This unexpected finding occurred consistently across nearly all CAG referral categories. Conclusions Despite more advanced age and a higher proportion of subjects with ‘any’ coronary atherosclerosis on CAG, the likelihood of a ‘negative’ angiogram (lesion(s) < 50%; no further evaluation/intervention) has increased significantly over the last decade. The exact nature of this phenomenon requires further investigation, particularly as a reverse trend would be expected with the growing role (and current high penetration) of contemporary non-invasive diagnostic tools to rule out significant CAD.