Coronary computed tomography angiography versus invasive coronary angiography: medical staff perceptions and diagnostic
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ORIGINAL ARTICLE
Coronary computed tomography angiography versus invasive coronary angiography: medical staff perceptions and diagnostic interest in Gaza-Palestine Husam H. Mansour 1,2 & Yasser S. Alajerami 2 & Ahmed A. Najim 3 Received: 10 August 2020 / Accepted: 22 September 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background Invasive coronary angiography (ICA) and coronary computed tomography angiography (CCTA) are used in the diagnosis of coronary artery disease (CAD). The medical benefits, as well as the ethical and logistical implications, should be explored, particularly in the scarcity of medical resources. We explore the perception of medical staff toward the interest of CCTA and ICA in diagnosis CAD to maximize the utility of both procedures. Methods A triangulated observational, analytical prospective cohort study carried out among patients suspected with CAD who underwent CCTA and ICA. The quantitative part included 381 patients (250 underwent ICA and 131 underwent CCTA). The qualitative part included a purposive sample of two radiologists, three cardiologists, and two medical imaging specialists. Results Low diagnostic yield of the ICA through 31.3% and 39.7% diagnosed without CAD and non-significant CAD, respectively. Risk factors such as the family history of heart disease, obesity, high cholesterol, and diabetes were with high frequency in the patients with significant CAD. The sensitivity, specificity, PPV, and NPV of CCTA technique was 94.74%, 94.23%, 92.31%, and 96.08% respectively. Cardiologist’s perceptions focused on radiation concerns and difficulties for convincing patients to perform the CCTA procedure. Radiologists and medical imaging specialists focused on complete cooperation from the cardiologist to better preparation of patients to perform optimal CCTA procedures. Conclusion Efficient diagnostic benefits of CCTA and overuse of ICA for stable CAD are documented. Clear diagnostic strategy with medical, ethical, and logistical issues should be considered when selecting the CCTA or ICA for diagnosis CAD. Keywords Coronary computed tomography angiography . Diagnostic interest . Invasive coronary angiography
Introduction The preliminary diagnosis of patients with suspected coronary artery disease (CAD) can reduce adverse health events and persevere in life [1]. Currently, invasive coronary angiography (ICA) is the gold standard for the assessment of coronary anatomy and the presence, localization, and severity of CAD. ICA allows immediate intervention if stated with * Husam H. Mansour [email protected] Yasser S. Alajerami [email protected] 1
Radiology Department, Al-Shifa Hospital, Gaza, Palestine
2
Medical Imaging Department, Al-Azhar University, Gaza, Palestine
3
Nursing Department, Al-Azhar University, Gaza, Palestine
stenosis. However, according to the previous study, over 50% of the subjects who undergo elective ICA have no significant coronary artery stenosis [2]. Therefore, a comparably accurate, non-invasive, and reliable screening modality for d
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