Non-invasive assessment prior to invasive coronary angiography in routine clinical practice in Switzerland – Is it according to the guidelines?
CH-Guideline · 2019 · Switzerland
Source and licence
- Authors
- Rebecca Schiefer, Hans Rickli, Evelyne Neurauter et al.
- Title
- Non-invasive assessment prior to invasive coronary angiography in routine clinical practice in Switzerland – Is it according to the guidelines?
- Journal
- PLoS ONE, 2019
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC6731015
Licence statement of the original publication
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Open the original publication →Full text on Europe PMC
Recommendations
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Abstract
Background: Non-invasive testing is recommended as a basis to decide about the indication for invasive coronary angiography (ICA) in patients with suspected stenotic coronary artery disease (CAD). However, a recent study based on insurance claims data reported that one third of patients undergoing ICA in Switzerland did not have non-invasive testing beforehand. We aimed to re-evaluate the practice of testing prior to ICA in Switzerland by manual review of patient histories.
Methods: Retrospective analysis of all 816 consecutive patients (age 67±9 years, 70% males) undergoing elective ICA solely for the evaluation of stenotic CAD during the year 2015 in a single center in Eastern Switzerland. The proportion of patients undergoing a non-invasive test was assessed, and predictors of the lack of such a test were determined.
Results: 764/816 (94%) patients had a non-invasive test prior to ICA. The majority of patients (728/816; 89%) had an exercise stress test, one fifth (160/816; 20%) underwent a test other than an exercise stress test (6% scintigraphy, 4% stress echocardiography, 6% stress magnetic resonance imaging, 4% computed tomography coronary angiography), and 122/816 (15%) patients had two tests. The use of antianginal drugs other than beta-blockers [odds ratio 1.92 (95% confidence interval 1.01–3.66); p = 0.047] and a lower left ventricular ejection fraction [odds ratio 0.97 (95% confidence interval 0.94–0.99) per one % point increase; p = 0.005] were independent predictors of the lack of a non-invasive test. ICA revealed stenotic CAD in 72% of patients, and 54% of patients underwent revascularization. Patients with and without non-invasive tests did not differ with respect to ICA findings and management.
Conclusions: The present analysis suggests that patients are appropriately selected for ICA based on clinical judgement and non-invasive testing in Switzerland. There is no evidence for an overuse of ICA.
Contents of the original publication
The section headings of the original.
- Introduction
- Methods
- Study design
- Study population
- Assessment of pre-test probability
- Definition of non-invasive tests
- Invasive coronary angiography
- Statistical analysis
- Results
- Study population
- Non-invasive tests
- Predictors of the lack of a non-invasive test
- Results of ICA
- Patients with stenotic CAD not undergoing revascularization
- Discussion
- Limitations
- Conclusions
- Supporting information
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