Abstract 14288: Improvement and Problems in Appropriate Use of Cardiac CT: 2003, 2007 and 2011 Use of CT Based on ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac CT

Abstract

Purpose: It is important to perform cardiac CT based on ACCF 2010 appropriate use criteria (AUC). We evaluated appropriateness of CT use in 2003 and 2007 by AUC of 16[[Unable to Display Character: ‐]]slice CT, and in 2011 by AUC of 320-slice CT.

Materials and methods: We retrospectively analyzed the purpose of cardiac CT in a total of 720 subjects. Subjects were consecutively recruited at this institute in 2003 (218; 128 males, mean age 63 years), in 2007 (201; 124 males, 61 years), and 2011 (301; 175 males, 62 years).

Results: Rate of appropriate CT use was 55% of subjects in 2003, and improved to 75% in 2007 and 81% in 2011. Appropriateness of detection of coronary artery disease was 42% in 2003, and improved to 55% in 2007 and 77% in 2011; this was because CT was mainly performed for symptomatic subjects. Rate of appropriate evaluation of cardiac structure and function was 90% in 2003, and improved to 91% in 2007 and 100% in 2011, mainly because poor quality images were obtained from other noninvasive modalities. Rate of inappropriate risk assessment of post revascularization was 24% in 2003, and progressively worsened to 33% in 2007 and 72% 2011, mainly because evaluation of patency of coronary artery bypass graft (CABG) was frequently performed in asymptomatic subjects <5 years after the procedure. Rate of appropriate preoperative evaluation was 62 % in 2003, and improved to 57% in 2007 and 27% in 2011, mainly because CT was performed before intermediate risk surgery and subjects were selected with functional capacity <4 metabolic equivalents (METs) with ≥1 clinical risk predictors.

Conclusion: Appropriate use of CT improved but appropriate risk assessment of post revascularization progressively worsened from 2003 to 2007 to 2011. It is important to recognize that CT evaluation of patency of CABG in asymptomatic subjects <5 years after operation is inappropriate.