Cardiac Cta Utilization for Chest Pain Stratification Increased During and After the Covid-19 Pandemic: Experience of a Latin-American Center

Introduction: During the COVID-19 pandemic, stratification of patients with chest pain with low-to-moderate probability of CAD (LMCP) became problematic due to fear of infection. We analyzed the impact in volume trends of modalities for stratification in these patients -including stress echocardiography (S-TTE), cardiac computed tomography (CCT), and single-photon emission CT (SPECT)- before, during, and after the pandemic Hypothesis: Usage of CCT increased during the COVID-19 pandemic due to the lower exposure of patients, during this test, to healthcare personnel. Methods: R etrospective chart review conducted between 2019 and 2021. We defined 3-time frames: pre-pandemic period (1/1/2019-12/31/2019), pandemic period (1/1/2020-12/31/2020), and post-pandemic period (1/1/2021-12/31/2021). The study included data of all 3 mentioned imaging modalities. Results: Our cohort included 19,637 LMCP patients evaluated using 1,369 CCTs (7%), 2,380 S-TTEs (13.6%) and 15,588 SPECTs (79.4%) -Fig 1a-. During the pre-pandemic period, CCT studies corresponded to 3.0%, while S-TTE and SPECT corresponded to 14.7% and 82.4%, respectively. In the post-pandemic period, CCT studies corresponded to 9.8%, while S-TTE and SPECT corresponded to 12.3% and 77.9%, respectively. An upward variation was observed regarding the utilization of CCT in the post-pandemic period compared to the pre-pandemic period (p<0.001), and a downward change was observed in S-TTE when the post-pandemic period was compared with the pre-pandemic period (p<0.001) -Fig 1b-. Conclusions: Since the beginning of the COVID-19 pandemic, the utilization of SPECT and s-TTE in LMCP patients decreased compared to the pre-pandemic period. In the post-pandemic period, both tests increased in use although their volumes are lower compared to the pre-pandemic period. Conversely, CCT had a linear increase since the beginning of the pandemic and this pattern has extended to the post-pandemic period.