Coronary CT angiography (CCTA) and fractional flow reserve with CCTA (FFRCT) have been endorsed by the ACC/AHA Chest Pain guidelines to streamline the diagnosis of coronary artery disease (CAD), but there is still a significant lack of adherence. In our study of 673 stable chest patients without known CAD from 5 European countries, we found that CCTA is the most common noninvasive diagnostic test, but nearly 40 % of them still underwent upfront CAD. Additionally, there was no temporal improvement trend, and the integration of FFRCT is low. We highlighted the urgent need to improve diagnostic processes and update reimbursement policies.
Keywords: Coronary computed tomography angiography; Guidelines; Invasive coronary angiography; Non-invasive imaging; Pre-test probability.
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