Coronary computed tomography angiography versus invasive coronary angiography: medical staff perceptions and diagnostic interest in Gaza-Palestine.

Abstract

Invasive coronary angiography (ICA) and coronary computed tomography angiography (CCTA) are used in the diagnosis of coronary artery disease (CAD). The medical benefits, as well as the ethical and logistical implications, should be explored, particularly in the scarcity of medical resources. We explore the perception of medical staff toward the interest of CCTA and ICA in diagnosis CAD to maximize the utility of both procedures. A triangulated observational, analytical prospective cohort study carried out among patients suspected with CAD who underwent CCTA and ICA. The quantitative part included 381 patients (250 underwent ICA and 131 underwent CCTA). The qualitative part included a purposive sample of two radiologists, three cardiologists, and two medical imaging specialists. Low diagnostic yield of the ICA through 31.3% and 39.7% diagnosed without CAD and non-significant CAD, respectively. Risk factors such as the family history of heart disease, obesity, high cholesterol, and diabetes were with high frequency in the patients with significant CAD. The sensitivity, specificity, PPV, and NPV of CCTA technique was 94.74%, 94.23%, 92.31%, and 96.08% respectively. Cardiologist's perceptions focused on radiation concerns and difficulties for convincing patients to perform the CCTA procedure. Radiologists and medical imaging specialists focused on complete cooperation from the cardiologist to better preparation of patients to perform optimal CCTA procedures. Efficient diagnostic benefits of CCTA and overuse of ICA for stable CAD are documented. Clear diagnostic strategy with medical, ethical, and logistical issues should be considered when selecting the CCTA or ICA for diagnosis CAD.