Abstract 16451: The Temporal Trend in the Utilization of Noninvasive Cardiac Test for Chest Pain Evaluation and Its Impact on Cardiac Catheterization Trends

Introduction: Noninvasive diagnostic testing serves as gatekeepers to invasive cardiac catheterization. Computed tomography coronary angiogram (CTCA) has been shown to have high sensitivity and negative predictive value in the diagnosis of coronary artery disease (CAD). However, the temporal trend of CTCA compared to functional tests and the differential downstream impact on cardiac catheterization is unknown. Objective: This study aimed to investigate the temporal trend of the use in CTCA for the evaluation of patients with chest pain and how it compares to the temporal trend of stress testing. The secondary aim was to investigate the temporal pattern in the cardiac catheterization rate and how it varies between CTCA and stress testing. Methods: We performed a retrospective review of 65,686 patients who presented to a large academic medical center with chest pain between 2012 and 2019. We identified those who received CTCA testing or stress testing as the initial diagnostic testing for diagnosing suspected CAD and collected data on downstream cardiac catheterization. We calculated the testing rate per 1000 for each year. Results: Of the patient who received noninvasive imaging (n=18,843), more CTCA was performed (18.6%) compared to stress test (10.1%). After an initial upward trend in CCTA use and a downward trend in stress test use between 2012 and 2014, the trend reversed for both modalities after 2015. The rate of cardiac catheterization increased after 2014, mirroring an increase in stress test utilization. Patients who had stress test first have increased odds of undergoing catheterization compared to those who had CTCA first, even after adjusting for risk factors. However, compared to CTCA, stress test shows a relative decline in the odds of catheterization (Relative adjusted Odd Ratio: 5.6 in 2012 down to 2.8 in 2019) Conclusion: In this large single-center study of chest pain patients, stress-testing leads to increased odds of cardiac catheterization compared to CCTA. However, the relative odds of undergoing catheterization following stress testing show a declining trend.