Evidence map›Paper›PMID 38038185›Full record

ArticleJournal of the American Heart Association2023

Safe Deferral of Coronary Computed Tomography Angiography for Patients With a Low Pretest Probability of Coronary Artery Disease in 2019 European Society of Cardiology Guidelines.

Ville Varho, Valtteri Uusitalo, Satu M Vaara, Suvi Syväranta, Helena Rajala, Juha Sinisalo

Open access · goldAbstract read
In one paragraph

Article in Journal of the American Heart Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.9field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 4 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Ville VarhoCardiology, Heart and Lung Center Helsinki University Hospital and University of Helsinki Helsinki Finland.ORCID 0000-0001-9688-5322
Valtteri UusitaloClinical Physiology and Nuclear Medicine, Diagnostic Center Helsinki University Hospital and University of Helsinki Helsinki Finland.ORCID 0000-0001-7345-7122
Satu M VaaraRadiology, Diagnostic Center Helsinki University Hospital and University of Helsinki Helsinki Finland.
Suvi SyvärantaRadiology, Diagnostic Center Helsinki University Hospital and University of Helsinki Helsinki Finland.ORCID 0000-0003-1889-3858
Helena RajalaCardiology, Heart and Lung Center Helsinki University Hospital and University of Helsinki Helsinki Finland.
Juha SinisaloCardiology, Heart and Lung Center Helsinki University Hospital and University of Helsinki Helsinki Finland.ORCID 0000-0002-0169-5137
University of Helsinki · FI

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCoronary computed tomography angiography is increasingly used as the first-line test for suspected coronary artery disease. Its overuse in a low pretest probability (PTP) population may lead to low diagnostic yield without change in patient management. We evaluated the clinical consequences of the updated 2019 European Society of Cardiology (ESC) chronic coronary syndromes guidelines' PTP estimation and whether imaging could be safely deferred in patients with a low PTP. METHODS AND

resultsThis retrospective cohort included all 1753 consecutive patients who underwent coronary computed tomography angiography for suspected coronary artery disease at Helsinki University Hospital between 2009 and 2017. PTP was calculated according to the 2013 and 2019 ESC guidelines. The overall mortality, cardiac deaths, myocardial infarctions, and hospitalizations for unstable angina were acquired from national registry data for 1 to 10 years of follow-up (median, 4 years). Updated 2019 ESC guidelines classified 72% of the patients as having low PTP, whose imaging could have been deferred. The revascularization rate (4.7%) and annual cardiac mortality (0.4%) were low in the 857 patients reclassified from the recommendation to test, according to the 2013 ESC guideline, to deferral of coronary computed tomography angiography, according to the new 2019 guideline.

conclusionsThe updated 2019 ESC guideline PTP score aids clinicians in safely preventing the overuse of cardiac imaging in patients deemed at low PTP of coronary artery disease. Diagnostic yield, revascularization rate, and cardiac mortality are low in patients with low pretest risk.

Indexed as

CardiologyCoronary Artery DiseaseComputed Tomography AngiographyCoronary AngiographyHumansProbabilityRetrospective Studiescardiac imagingchest painchronic coronary syndromediagnostic yieldprognosis

Identifiers

PMID38038185
PMCPMC10727332
OpenAlexW4389244457

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.