The lack of growth in use of coronary CT angiography: is it being appropriately used?

摘要

OBJECTIVE: The purpose of this article is to study recent utilization trends in coronary CT angiography (CTA) and compare them with radionuclide myocardial perfusion imaging (MPI), a competing procedure. MATERIALS AND METHODS: The nationwide Medicare Part B databases were used to determine utilization rates per 100,000 beneficiaries. Rates for coronary CTA were studied from 2006 (the first year Current Procedural Terminology codes were available for this procedure) through 2008. Rates for MPI were studied from 1998 through 2008. Medicare specialty codes were used to identify examinations done by radiologists and cardiologists. RESULTS: The coronary CTA total utilization rate per 100,000 rose from 99 in 2006 to 210 in 2007 (112%) but then decreased to 193 in 2008 (-8%). The rate for MPI increased from 4748 in 1998 to a peak of 8753 in 2006 (84%), then declined to 8467 in 2008. Cardiologists performed the majority of both coronary CTA and MPI. In 2008, MPI was performed 44 times as often as coronary CTA. CONCLUSION: Given that coronary CTA is a new procedure that has aroused much interest and has been shown to have very favorable results, the drop in its utilization rate in 2008 was surprising. A review of the literature indicates that there are shortcomings to the clinical diagnosis of coronary artery disease (which often includes the use of MPI), that coronary CTA can be used to stratify risk, and that it can expedite the workup of patients with acute chest pain in emergency departments. The evidence from the literature review suggests that both invasive coronary angiography and MPI may be overutilized, whereas coronary CTA is probably underutilized.