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<p> As from January 1st 2025, noninvasive coronary angiography with computed tomography (CCTA) was included as a new service of the statutory health insurance (GKV) for patients with suspected chronic coronary heart disease (CHD: chronic coronary syndrome, CCS). However, many questions remained unanswered for this indication of suspected epicardial stenosing chronic CHD as the cause of the complaints described by the patient with a pretest probability (PTP) of 15–50%. The lack of specifications by which the PTP should be calculated, lead to uncertainties. It is all the more important to remove this ambiguity as both the level of the PTP and the score used in the calculation must be described in the letter of referral. In Germany, different scores are recommended for the calculation of the PTP: the National Treatment Guidelines of the German Medical Association (NVL) recommend the Marburg Heart Score for general practitioners but the DISCHARGE score for medical specialists. The European Society of Cardiology (ESC) guidelines recommend the updated risk factor-weighted clinical likelihood (RF-CL) score. After a thorough analysis of the advantages and limitations of these three different scores, the German Cardiac Society (DGK) recommends the ESC RF-CL score for all groups of physicians—as only this score considers important cardiovascular risk factors and also exertional dyspnea as a possible equivalent of angina pectoris in the calculation of the PTP. Furthermore, from a cardiological perspective, the obligatory “treatment recommendation”—which goes beyond the purely imaging interpretation—is very problematic. The majority of radiologists give their recommendations on further treatments according to the CAD-RADS 2.0 score. The inclusion of cardiological expertise, however, is not absolutely necessary, not even for “unclear or complex results”. For GKV patients, the CCTA is not approved for asymptomatic patients or for symptomatic patients with a PTP &lt; 15% or &gt; 50% and also not for those with known CHD. If from a medical perspective a CCTA is indicated in patients with known CHD in order to avoid a possible unnecessary cardiac catheterization, this can only be carried out if the patient pays on its own—in the same way as the lone assessment of the coronary calcium score as an important prognostic parameter and decision aid for a primary preventive medication.</p>

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Bewertung der nichtinvasiven CT-Koronarangiographie (CCTA) als neue Leistung der gesetzlichen Krankenversicherungen: Für welche Patienten ist sie zugelassen? Für welche nicht? Was ist zu beachten? – DGK-Stellungnahme

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  • 发表日期：

    2026年1月28日

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  • Sigmund Silber,
  • Tilman Schneider,
  • Julinda Mehilli,
  • Andreas Rolf

摘要

As from January 1st 2025, noninvasive coronary angiography with computed tomography (CCTA) was included as a new service of the statutory health insurance (GKV) for patients with suspected chronic coronary heart disease (CHD: chronic coronary syndrome, CCS). However, many questions remained unanswered for this indication of suspected epicardial stenosing chronic CHD as the cause of the complaints described by the patient with a pretest probability (PTP) of 15–50%. The lack of specifications by which the PTP should be calculated, lead to uncertainties. It is all the more important to remove this ambiguity as both the level of the PTP and the score used in the calculation must be described in the letter of referral. In Germany, different scores are recommended for the calculation of the PTP: the National Treatment Guidelines of the German Medical Association (NVL) recommend the Marburg Heart Score for general practitioners but the DISCHARGE score for medical specialists. The European Society of Cardiology (ESC) guidelines recommend the updated risk factor-weighted clinical likelihood (RF-CL) score. After a thorough analysis of the advantages and limitations of these three different scores, the German Cardiac Society (DGK) recommends the ESC RF-CL score for all groups of physicians—as only this score considers important cardiovascular risk factors and also exertional dyspnea as a possible equivalent of angina pectoris in the calculation of the PTP. Furthermore, from a cardiological perspective, the obligatory “treatment recommendation”—which goes beyond the purely imaging interpretation—is very problematic. The majority of radiologists give their recommendations on further treatments according to the CAD-RADS 2.0 score. The inclusion of cardiological expertise, however, is not absolutely necessary, not even for “unclear or complex results”. For GKV patients, the CCTA is not approved for asymptomatic patients or for symptomatic patients with a PTP < 15% or > 50% and also not for those with known CHD. If from a medical perspective a CCTA is indicated in patients with known CHD in order to avoid a possible unnecessary cardiac catheterization, this can only be carried out if the patient pays on its own—in the same way as the lone assessment of the coronary calcium score as an important prognostic parameter and decision aid for a primary preventive medication.