P14 Downstream investigation following CT coronary angiography: an audit of practice in a UK centre

Introduction In the UK, national guidance on the assessment of cardiac sounding chest pain (NICE CG95 2016), advises that CT coronary angiography (CTCA) is the first line imaging modality. If this reveals coronary artery disease of uncertain functional significance or is non-diagnostic, non-invasive functional testing is advised as second line. Invasive coronary angiography is only advocated as third-line when functional imaging is inconclusive or if intervention is planned and should not be performed merely to ‘check’ CTCA. We present an audit to assess the adherence to this national guidance in our centre. Methods Retrospective analysis of 281 consecutive CTCA performed between July 2017 to June 2018 and October 2018 to January 2019. Data collected include demographics, CAD-RADS score, and the presence/absence of any subsequent functional imaging, invasive angiography, PCI, or CABG up until the data collection time-point (September 2019). Results 276 scans were suitable for analysis and, out of these, 231 (84%) were discharged without further investigation. A total of 24 patients underwent subsequent functional imaging and 25 underwent invasive coronary angiography; in 16 of these patients (64%) no revascularisation was performed. Conclusion Overall adherence to the guidelines at our institution is good with the majority of patients (84%) discharged without further investigation. Importantly, in 64% of patients undergoing invasive angiography no intervention was performed, suggesting that some of these may be unnecessary.