Use of cardiac imaging in chronic coronary syndromes: the EURECA Imaging registry.

Background: The prospective, multicentre EURECA registry assessed the use of imaging and adoption of the European Society of Cardiology (ESC) Guidelines (GL) in patients with chronic coronary syndromes (CCS).
Methods: Between May 2019 and March 2020, 5156 patients were recruited in 73 centres from 24 ESC member countries. The adoption of GL recommendations was evaluated according to clinical presentation and pre-test probability (PTP) of obstructive coronary artery disease (CAD).
Results: The mean age of the population was 64 ± 11 years, 60% of patients were males, 42% had PTP >15%, 27% had previous CAD, and ejection fraction was <50% in 5%. Exercise ECG was performed in 32% of patients, stress imaging as the first choice in 40%, and computed tomography coronary angiography (CTCA) in 22%. Invasive coronary angiography (ICA) was the first or downstream test in 17% and 11%, respectively. Obstructive CAD was documented in 24% of patients, inducible ischaemia in 19%, and 13% of patients underwent revascularization. In 44% of patients, the overall diagnostic process did not adopt the GL. In these patients, referral to stress imaging (21% vs. 58%; P < 0.001) or CTCA (17% vs. 30%; P < 0.001) was less frequent, while exercise ECG (43% vs. 22%; P < 0.001) and ICA (48% vs. 15%; P < 0.001) were more frequently performed. The adoption of GL was associated with fewer ICA, higher proportion of diagnosis of obstructive CAD (60% vs. 39%, P < 0.001) and revascularization (54% vs. 37%, P < 0.001), higher quality of life, fewer additional testing, and longer times to late revascularization.
Conclusions: In patients with CCS, current clinical practice does not adopt GL recommendations on the use of diagnostic tests in a significant proportion of patients. When the diagnostic approach adopts GL recommendations, invasive procedures are less frequently used and the diagnostic yield and therapeutic utility are superior.
Competing Interests: Conflict of interest: C.-H.S., R.L., M.H.M., D.N., A.S., J.V., A.C., A.I.G., S.S., C.B., C.L., F.P., T.P., M.C., F.M., T.E., B.C., J.M., C.A., and B.A.P. declare no conflict of interest. A.G. reports consultancy to Pfizer and GE Healthcare (paid to FTGM). J.L.Z. reports a grant from Abbott and honoraria from Bayer, Daichii, Pfizer, and Edwards. G.P. reports grants, honoraria or consulting fees, honorarium as speaker, and/or institutional research funding from GE Healthcare, Bracco, Boehringer, Heartflow. J.K. reports honoraria from GE Healthcare, Merck, Lundbeck, Bayer, Boehringer-Ingelheim, Pfizer. S.E.P. reports consultancy to and stock ownership of Circle Cardiovascular Imaging Inc, Calgary, Alberta, Canada. V.D. reports grants or contracts from Abbott Vascular, Bayer, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, Ionis, Medtronic (paid to the Department of Cardiology of the Leiden University Medical Center). Honoraria from Abbott Vascular, Edwards Lifesciences, GE Healthcare, MSD, Novartis, Medtronic. N.M.-V. reports a leadership or fiduciary role: Member of expert board of Belarusian Republican Foundation for Fundamental Research. A.S. reports honoraria from Abbott, Amgen, Astra Zeneca, Bayer, Boehringer-Ingelheim, and Pfizer.
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