Increased Use of CCTA Cost Effective for Diagnosing Coronary Artery Disease

Radiologic screening opportunities are on the increase in the field of cardiology. A new retrospective study examined the results in the United Kingdom of the National Institute for Health and Care Excellence (NICE)’s 2016 recommendation that coronary CT angiography (CCTA) be used as the first-line test for potential angina.

Research, led by Jonathan Weir-McCall, PhD and his colleagues, was published in the JACC: Cardiovascular Imaging. Their study reviewed over 1.9 million patients suspected of having coronary artery disease (CAD) between 2012 and 2018. Researchers wanted to learn the impact of CCTA after the NICE 2106 updated recommendations for care in new patients experiencing chest pain.

The research team saw positive results:

1. CCTA usage rose in response to the 2016 NICE recommendation for CCTA for first-line testing.
2. In areas of high usage of CCTA, researchers discovered decreased hospitalization for myocardial infarction and a decrease in cardiovascular mortality and ischemic heart disease deaths, trending towards an overall decline in overall mortality.
3. Although usage of CCTA increased overall imaging studies, costs remained stable, only rising with inflation.

Edward Nicol, MD, MBA, FSCCT, co-author and president-elect of the Society of Cardiovascular Computed Tomography (SCCT), noted, “These real-world findings in a very large patient cohort provide strong evidence that the use of CCTA as a first-line investigation in those with suspected coronary artery disease reduces cardiovascular mortality, and proves the use of CCTA as the first-line test — as proposed in the U.K. NICE guidance — is highly cost-effective.”

A critical reason that increased use of CCTA is more cost-effective is that it decreases the use of the more invasive and expensive coronary angiography procedure.

In the United States, there is considerable interest in CCTA — particularly in utilizing artificial intelligence (AI) in CCTA. This combination of technology was designed by HeartFlow, and the American Heart Association and American College of Cardiology 2021 Chest Pain Guidelines agree that it is both “reasonable and effective” for diagnosing CAD.

CCTA supporters predict now that CCTA has risen to a front-line commendation and that impact here in the U.S. will be similar to that in the U.K. Most experts believe that cardiac CT is poised for substantial growth in the coming years.