Coronary Artery Disease
Conditions
Keywords
Angiogram, Coronary Computed Tomographic Angiography
Brief summary
This study aims to reduce patient risk and costs to the healthcare system by improving the diagnostic yield of invasive coronary angiography through existing triage processes to improve risk stratification using Coronary Computed Tomographic Angiography (CCTA) as a first step in low risk patients. All low-risk patients referred for invasive coronary angiography will be potentially eligible for CCTA instead of invasive angiography as a first-line diagnostic test. All CCTAs will be read by both a level 3-trained cardiologist and a radiologist. The results of the CCTA, coupled with evidence-based management recommendations will be sent to the referring physician and an invasive angiogram will be arranged by the HIU triage, only when clearly indicated
Interventions
DIAGNOSTIC_TESTCoronary Computed Tomographic Angiography
All low-risk patients referred for invasive coronary angiography will be potentially eligible to receive the intervention over a 12-month period. The intervention will include risk stratification using Coronary Computed Tomographic Angiography (CCTA) at HHS and NHS as an alternative to upfront invasive angiography. All CCTAs will be read by both a level 3-trained cardiologist and a radiologist. The results of the CCTA, coupled with evidence-based management recommendations will be sent to the referring physician and an invasive angiogram will be arranged only when indicated as per these management recommendations
Sponsors
Hamilton Academic Health Sciences Organization
Hamilton Health Sciences Corporation
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Non urgent outpatient referral 2. Canadian Cardiovascular Society class I or II 3. Indication for invasive angiogram includes: Rule out Coronary Artery Disease (CAD) and Cardiomyopathy
Exclusion criteria
1. Age \<18 years old, Men \>65 years old or women \>75 years old 2. Patient refusal to provide verbal consent for CCTA at time of triage contact or unable to provide informed consent 3. Referring physician refusal for their eligible patients to be approached for the CarDIA study 4. Any prior CCTA 5. Atrial Fibrillation 6. Creatinine \> 150 mmol/L 7. Diabetes mellitus 8. High risk Exercise Stress Test or Functional Imaging 9. Known severe valvular disease being considered for valve surgery 10. Any known CAD * Prior Acute Coronary Syndrome (ACS) * Prior Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft (CABG)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic yield of invasive angiography | Three years | Diagnostic yield is defined as the proportion of invasive angiograms that identify significant disease (≥70% stenosis) on a major coronary vessel (\>2 mm) or \> 50% stenosis in the left main) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quantitative assessment of angiograms avoided | Three years | Number of angiograms avoided due to CCTA bookings |
| Deviation from management recommendations following CCTA | Three years | Number of angiograms performed when not recommended |
| Protocol deviation as a surrogate for acceptability of the novel triage program | Three years | Percentage of patients and physicians refusing to undergo CCTA as a first step |
| Costing of new strategy | Three years | Cost of risk stratification of Coronary Artery Disease in low risk patients |
Countries
Canada
Outcome results
None listed