Evaluation of patient-reported outcomes in coronary CT angiography versus invasive coronary angiography

<h2>Abstract</h2><h3>Objectives</h3> Coronary computed tomography angiography (CCTA) is the preferred non-invasive method for excluding coronary artery disease (CAD) in patients with an intermediate pre-test probability or stable CAD and often replaces invasive coronary angiography (ICA). However, patient acceptance and emotional responses to CCTA remain insufficiently studied. This study evaluated patient acceptance and emotional experiences during CCTA through patient-reported outcomes (PROs). <h3>Materials and methods</h3> A total of 151 patients with a clinical indication for CCTA underwent standardized Dual-Source CT or Photon-Counting CT of the heart; 69 of these patients had previously undergone ICA. After the examination, a voluntary and anonymous PRO survey was completed using a standardized questionnaire comprising 27 items assessing emotions before and during the procedures. Responses were rated on 5-point Likert scales and visual analogue scales and compared with reported emotional responses to ICA and other semi- or non-invasive cardiac diagnostic procedures, including transesophageal echocardiography (TEE) and electrocardiography (ECG). <h3>Results</h3> Overall, 82% (124/151) of patients rated CCTA as "very pleasant" or "pleasant", compared to 29% (20/69) for ICA. 18% (27/151) rated CCTA as "very unpleasant" or "unpleasant", versus 71% (49/69) for ICA. Mean examination comfort was significantly higher for CCTA (4.3/5) than for ICA (2.0/5; p < 0.001). Fear prior to examination was reported in 39.7% (60/151) for CCTA vs. 66.7% (46/69) for ICA (p < 0.001). Other non-invasive cardiac procedures were rated as mostly neutral compared to CCTA (range 2.2–3.3; 3 = neutral). <h3>Conclusion</h3> CCTA is well tolerated and demonstrates significantly higher patient acceptance, with lower fear and discomfort, compared with ICA. <h3>Clinical relevance statement</h3> This study underscores the clinical advantages of non-invasive CCTA beyond its established diagnostic value, highlighting its benefits with respect to patient comfort and compliance.