1. Impact of atherosclerosis imaging-quantitative computed tomography on diagnostic certainty, downstream testing, coronary revascularization, and medical therapy: the CERTAIN study.
- Author
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Nurmohamed NS, Cole JH, Budoff MJ, Karlsberg RP, Gupta H, Sullenberger LE, Quesada CG, Rahban H, Woods KM, Uzzilia JR, Purga SL, Aquino M, Hoffmann U, Min JK, Earls JP, and Choi AD
- Subjects
- Humans, Male, Female, Middle Aged, Prospective Studies, Aged, Myocardial Revascularization, Tomography, X-Ray Computed methods, Coronary Artery Disease diagnostic imaging, Computed Tomography Angiography methods, Coronary Angiography methods, Cross-Over Studies
- Abstract
Aims: The incremental impact of atherosclerosis imaging-quantitative computed tomography (AI-QCT) on diagnostic certainty and downstream patient management is not yet known. The aim of this study was to compare the clinical utility of the routine implementation of AI-QCT versus conventional visual coronary CT angiography (CCTA) interpretation., Methods and Results: In this multi-centre cross-over study in 5 expert CCTA sites, 750 consecutive adult patients referred for CCTA were prospectively recruited. Blinded to the AI-QCT analysis, site physicians established patient diagnoses and plans for downstream non-invasive testing, coronary intervention, and medication management based on the conventional site assessment. Next, physicians were asked to repeat their assessments based upon AI-QCT results. The included patients had an age of 63.8 ± 12.2 years; 433 (57.7%) were male. Compared with the conventional site CCTA evaluation, AI-QCT analysis improved physician's confidence two- to five-fold at every step of the care pathway and was associated with change in diagnosis or management in the majority of patients (428; 57.1%; P < 0.001), including for measures such as Coronary Artery Disease-Reporting and Data System (CAD-RADS) (295; 39.3%; P < 0.001) and plaque burden (197; 26.3%; P < 0.001). After AI-QCT including ischaemia assessment, the need for downstream non-invasive and invasive testing was reduced by 37.1% (P < 0.001), compared with the conventional site CCTA evaluation. Incremental to the site CCTA evaluation alone, AI-QCT resulted in statin initiation/increase an aspirin initiation in an additional 28.1% (P < 0.001) and 23.0% (P < 0.001) of patients, respectively., Conclusion: The use of AI-QCT improves diagnostic certainty and may result in reduced downstream need for non-invasive testing and increased rates of preventive medical therapy., Competing Interests: Conflict of interest: N.S.N. is co-founder of Lipid Tools. M.A., U.H., J.K.M., and J.P.E. are employees of Cleerly Inc. A.D.C. reports grant support from GW Heart and Vascular Institute, equity in Cleerly, Inc., and consulting with Siemens Healthineers., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2024
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