Dossier n. 162/2008 [Abstract] Multislice computed tomography in the assessment of coronary artery disease. A systematic review and appropriateness criteria

This document reports the outputs of the project “Diagnostic impact of multislice computed tomography for coronary artery disease” funded by the Italian Ministry of Health - Ricerca finalizzata (ex art. 12). The goal of this project was to provide guidance to regional health policies concerning the following aspects:

• appropriate use of the multislice computed tomography (MSCT) in patients with known or suspected coronary artery disease;
• estimation of the regional needs for MSCT procedures;
• assessment of the potential impact of this technology on the volume of conventional coronary angiographies;
• identification of monitoring tools;
• conduction and update of a systematic review.

In relation to the first aspect, the use of MSCT is considered clinically appropriate in patients with suspected coronary artery disease if the results of the stress tests are equivocal or discordant; in patients with dilated cardiomyopathy, mitral-aortic valvulopathy, aortic disease; in patients candidated for the implant of a cardiac defibrillator. However, with the current evidence the use of MSCT as primary screening test in asymptomatic patients is not justified.

Regarding the second aspect, it has been estimated that 2,000 MSCT procedures per year are needed in the region. According to our calculation, the use of the technology in the above mentioned indications could reduce the number of conventional coronary angiographies by an approximate 5% at regional level.

Lastly, the minimum dataset to monitor the appropriateness of MSCT use in clinical practice was identified by cardiologists and radiologists who participated in the group work, and a regional registry was implemented. This database will be used to carry out additional research to understand the real impact of the technology on the clinical outcomes of patients and the organisation.