Refereed journal article or data article (A1)
Use of cardiac imaging in chronic coronary syndromes: the EURECA Imaging registry
List of Authors: Neglia Danilo, Liga Riccardo, Gimelli Alessia, Podlesnikar Tomaž, Cvijić Marta, Pontone Gianluca, Miglioranza Marcelo Haertel, Guaricci Andrea Igoren, Seitun Sara, Clemente Alberto, Sumin Alexey, Vitola João, Saraste Antti, Paunonen Christian, Sia Ching-Hui, Paleev Filipp, Sade Leyla Elif, Zamorano Jose Luis, Maroz-Vadalazhskaya Natallia, Anagnostopoulos Constantinos, Macedo Filipe, Knuuti Juhani, Edvardsen Thor, Cosyns Bernard, Petersen Steffen E, Magne Julien, Laroche Cecile, Berlè Clara, Popescu Bogdan A, Delgado Victoria, EURECA Investigators
Publisher: Oxford Academic
Publication year: 2023
Journal: European Heart Journal
Journal name in source: European heart journal
Journal acronym: Eur Heart J
Volume number: 44
Issue number: 2
Start page: 142
End page: 158
ISSN: 0195-668X
eISSN: 1522-9645
DOI: http://dx.doi.org/10.1093/eurheartj/ehac640
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.
