ROME — As a gatekeeper to the cath lab, coronary CT angiography cut costs while maintaining equivalent patient outcomes, the CONSERVE investigators found.
Major adverse cardiovascular events occurred at the same 4.6% rate between patients whose treatment was guided by CT pre-screening and those that got direct invasive angiography (P=1.00), according to Hyuk-Jae Chang, MD, PhD, of South Korea’s Yonsei University College of Medicine in Seoul, at the European Society of Cardiology annual meeting.
Invasive imaging was reduced by almost 80% in stable patients without known coronary artery disease (CAD) if operators pre-screened them with CT (0.22 diagnostic catheterizations per patient versus 1.02, P<0.001). Revascularization was also less likely in this group (0.10 per patient versus 0.17, P<0.001).
These factors contributed to a halving in costs for patients undergoing a CT-first strategy ($3,338 versus $6,740, P<0.001).
“If we use coronary CT angiography as a gatekeeper to the catheterization lab in stable symptomatic patients with suspected CAD, we’ll reduce costs with sufficient safety,” Chang said in a press statement.
The CONSERVE investigators randomized 1,503 patients with suspected CAD to invasive coronary angiography (n=719) or a strategy contingent on CT results (n=784).
- Michael Valentine, MD, of Stroobants Cardiovascular Center in Lynchburg, Va., said that the question remains of how coronary CT angiography compares with othernon-invasive tests for CAD.
Additionally, “in the United States, there are many payers who are currently not paying for coronary CT angiography. Of course Medicare will pay for it, but if your payer will not pay for coronary CT angiography, it’s a problem,” Valentine, vice president of the American College of Cardiology, told MedPage Today.
Also missing from Chang’s data was the number of people who met appropriate use criteria for coronary angiography, according to Valentine. For those in the U.S., “one area that would be of concern to us is how would it change if you applied appropriate use?,” he said.
CONSERVE was funded by an unrestricted grant from GE Healthcare and Severance Hospital of Yonsei University.
Chang disclosed no relevant relationships with industry.
European Society of Cardiology
Chang H, et al “Coronary CT angiography for elective cardiac catheterization: Relation to cardiovascular outcomes, cost-effectiveness and quality of life” ESC 2016.