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Objectives <p>Coronary computed tomography angiography (CCTA) is highly effective for detecting coronary artery disease (CAD) but cannot assess its hemodynamic significance, often requiring additional tests. This study evaluates the clinical performance and cost-effectiveness of integrating dynamic myocardial CT perfusion (DynCTP) into the assessment of symptomatic patients with suspected CAD or prior chronic coronary syndrome (CCS).</p> Materials and methods <p>We conducted a single center, retrospective study comparing two matched cohorts. In the first cohort patients underwent CCTA followed by non-CT-based functional tests, while in the second cohort DynCTP was included for cases of potential functionally significant CAD. The study analyzed the number of additional tests, diagnostic process duration, and the incidence of major adverse cardiovascular events. A probabilistic cost analysis was performed to evaluate the economic impact.</p> Results <p>A total of 205 patients were included, 71% of whom were male, with a mean age of 72.5 ± 10 years. Over a follow-up of 30 months, the CCTA+DynCTP cohort showed a 56% reduction in additional tests and 45% in time to clinical decision-making, with a higher proportion of patients requiring only the initial study. No significant differences were observed in the number of invasive coronary angiograms or major adverse clinical events, although an increase in overall healthcare costs was documented.</p> Conclusion <p>Integrating DynCTP into the evaluation of symptomatic patients with suspected CAD or prior CCS streamlines the diagnostic process compared to a strategy based on CCTA and other functional tests, reducing time and additional testing without increasing adverse outcomes, although it is associated with slightly higher healthcare costs.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Evaluating the hemodynamic significance of coronary artery stenosis identified by coronary CT angiography is important to determine the best treatment strategy, but requires complementary tests</i>.</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>DynCTP reduced the time to clinical decision-making and the need for additional testing without increasing major adverse cardiovascular events</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>The integration of DynCTP safely streamlines the diagnostic process of CAD compared to a strategy based on CCTA and additional functional tests</i>.</p> Graphical Abstract <p></p>

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Cost-effective integration of dynamic myocardial CT perfusion in the assessment of symptomatic coronary artery disease

  • 期刊论文

  • 发表日期：

    2025年7月2日

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  • Carlos González-Freixa,
  • Francesc Altadill Balsells,
  • Lidia Bos Real,
  • Martín Descalzo Buey,
  • Juan Fernández Martínez,
  • Mario Salido Iniesta,
  • Konrad Pieszko,
  • Ruben Leta Petracca,
  • David Viladés Medel

摘要

Objectives

Coronary computed tomography angiography (CCTA) is highly effective for detecting coronary artery disease (CAD) but cannot assess its hemodynamic significance, often requiring additional tests. This study evaluates the clinical performance and cost-effectiveness of integrating dynamic myocardial CT perfusion (DynCTP) into the assessment of symptomatic patients with suspected CAD or prior chronic coronary syndrome (CCS).

Materials and methods

We conducted a single center, retrospective study comparing two matched cohorts. In the first cohort patients underwent CCTA followed by non-CT-based functional tests, while in the second cohort DynCTP was included for cases of potential functionally significant CAD. The study analyzed the number of additional tests, diagnostic process duration, and the incidence of major adverse cardiovascular events. A probabilistic cost analysis was performed to evaluate the economic impact.

Results

A total of 205 patients were included, 71% of whom were male, with a mean age of 72.5 ± 10 years. Over a follow-up of 30 months, the CCTA+DynCTP cohort showed a 56% reduction in additional tests and 45% in time to clinical decision-making, with a higher proportion of patients requiring only the initial study. No significant differences were observed in the number of invasive coronary angiograms or major adverse clinical events, although an increase in overall healthcare costs was documented.

Conclusion

Integrating DynCTP into the evaluation of symptomatic patients with suspected CAD or prior CCS streamlines the diagnostic process compared to a strategy based on CCTA and other functional tests, reducing time and additional testing without increasing adverse outcomes, although it is associated with slightly higher healthcare costs.

Key Points

Question Evaluating the hemodynamic significance of coronary artery stenosis identified by coronary CT angiography is important to determine the best treatment strategy, but requires complementary tests.

Findings DynCTP reduced the time to clinical decision-making and the need for additional testing without increasing major adverse cardiovascular events.

Clinical relevance The integration of DynCTP safely streamlines the diagnostic process of CAD compared to a strategy based on CCTA and additional functional tests.

Graphical Abstract