Nationwide Trends of Gatekeeper to Invasive Coronary Angiography in Suspected Coronary Artery Disease
- Author:
Min Jae CHA
1
;
William D KIM
;
Hoyoun WON
;
Jaeeun JOO
;
Hasung KIM
;
In-Cheol KIM
;
Jin Young KIM
;
Seonhwa LEE
;
Iksung CHO
Author Information
- Publication Type:Original Research
- From:Korean Circulation Journal 2022;52(11):814-825
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background and Objectives:Real-world trends in the utility and type of gatekeeping studies in invasive coronary angiography (ICA) requires further investigation.
Methods:We identified outpatients who underwent noninvasive cardiac tests or directly ICA for suspected coronary artery disease (CAD) from the nationwide Korea Health Insurance Review and Assessment Service-National Patient Sample database between 2012 and 2018.
Results:Among 71,401 patients, the percentage of patients who were evaluated for suspected CAD was 34.7% for treadmill test (TMT), 4.2% for single-photon emission computed tomography (SPECT), 24.2% for coronary computed tomography angiography (CCTA), 1.6% for multiple gatekeepers, and 32.3% for directly ICA without noninvasive studies. The proportion of CCTA as a gatekeeper showed linear increase, (18.6% in 2012 and 28.8% in 2018; p<0.001), while those of TMT, SPECT, and direct ICA have decreased (p<0.001, p=0.03, and p<0.001, respectively). The overall incidence of downstream ICA after gatekeeper was 13.8% (6,662/48,346), and SPECT showed higher ICA rate in pairwise comparison with TMT and CCTA (p<0.001). Patients who performed gatekeepers before ICA showed higher rate of subsequent PCI (34.7% vs. 32.3%; p<0.001) and CABG (3.5% vs. 1.0%; p<0.001), compared to those who directly underwent ICA, and CCTA was associated with higher revascularization rate after ICA in pairwise comparison with TMT and SPECT (p<0.001).
Conclusions:Nationwide database demonstrated that CCTA is utilized increasingly as a gatekeeper for ICA and is associated with high revascularization rate after ICA in outpatients with suspected CAD.
