Inpatient cardiac computed tomography angiography in Germany between 2005 and 2023: a nationwide registry study

Clinical Research in Cardiology https://doi.org/10.1007/s00392-026-02954-y ORIGINAL PAPER Inpatient cardiac computed tomography angiography in Germany between 2005 and 2023: a nationwide registry study Katharina A. Riedl1,2 · Bianca Strauß1 · Alexander Lenz3 · Isabel Molwitz3 · Jennifer Erley3 · Rickmer Braren3,4 · Stefan Blankenberg1,2 · Johannes T. Neumann1,2,5 Received: 17 February 2026 / Accepted: 21 May 2026 © The Author(s) 2026 Abstract Background Cardiac computed tomography angiography (CCTA) is a non-invasive imaging method, which enables detailed evaluation of the cardiac anatomy and the assessment of coronary artery disease (CAD). The diagnostic quality and availability improved, while data on the actual use of CCTA is sparse. We aimed to evaluate in-hospital CCTA utilization, the related diagnoses, and procedures in Germany in recent years. Methods Data from the Federal Statistical Office of Germany on all in-hospital CCTA cases between 2005 and 2023 was used. Clinical diagnoses, procedures, and in-hospital outcomes were analyzed. In subgroup analyses, we evaluated the use of CCTA among all cases with the primary diagnosis of CAD. Results A total of 475,740 cases (median age 72 [60, 80] years, 43.8% females) underwent CCTA. The most common primary diagnoses of the in-hospital CCTA scans were aortic valve diseases (28.7%), atrial fibrillation and flutter (19.5%), and CAD (16.4%). The majority of CCTA scans was performed in urban hospitals (59.3%). Over time, the number of CCTA substantially increased (factor 11). Among all cases with the primary diagnosis CAD (n = 12,153,473), a minority of 78,199 (0.6%) underwent CCTA scans. Among CAD, younger patients and more females received a CCTA scan and in these cases less invasive coronary angiographies and interventions were performed. Conclusions CCTA is increasingly used in cardiovascular care. Inpatient CCTA scans were performed for the evaluation of aortic valve diseases, atrial fibrillation and flutter and CAD. * Johannes T. Neumann 1 Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center HamburgEppendorf, Hamburg, Germany 2 German Center of Cardiovascular Research (DZHK), Partner Site North, Hamburg, Germany 3 Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 4 Chair for AI in Healthcare and Medicine, TUM University Hospital, School of Medicine, Technical University Munich, Munich, Germany 5 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Vol.:(0123456789) Clinical Research in Cardiology Graphical Abstract Keywords Cardiac computed tomography · In-hospital · Coronary artery disease · CCTA Introduction Cardiac computed tomography angiography (CCTA) is a non-invasive imaging method providing highly accurate information about the coronary and cardiac anatomy including vascular calcifications. This enables the usability of CCTA in a wide field of applications. Currently, there are three main areas, where CCTA provides important information. First, CCTA is commonly used to diagnose or rule out coronary artery disease (CAD) with a Class 1 A recommendation of the guidelines from the European Society of Cardiology in low to intermediate risk patients with suspected obstructive CAD [1, 2]. This is based on recent large studies like the DISCHARGE [3], PROMISE [4], and SCOT-HEART [5] trials. It should be emphasized that CCTA has long since ceased to be a purely rule-out diagnostic procedure. Second, CCTA is crucial for guiding structural valve disease interventions, especially transcatheter aortic valve implantation (TAVI) [6]. CCTA enables the pre-procedural evaluating of the femoral and aortic vessels, measuring of the diameter of the aortic valve annulus and assessing stenosis severity via calcium scoring and planimetry [7, 8]. Finally, CCTA is useful for guiding electrophysiological (EP) procedures such as ablations or the implantation of left atrial appendence (LAA) occlusion devices [9] as well as to exclude intracardiac thrombus before electrical cardioversion of cardiac arrhythmias or ablations in case of inability of transesophageal echocardiography [10]. Moreover, CCTAbased visualization was able to optimize ablation strategies and outcomes in recent studies by providing information about the exact cardiac anatomy and myocardial scars [11, 12]. Given the large number of patients with the aforementioned indications, the increasing method quality and wider availability with new CT detector generations, the use of CCTA is increasing globally. However, large-scale data on the actual use and indications for CCTA scans Clinical Research in Cardiology Fig. 1  Study Cohort. Between 2005 and 2023, CCTA was performed in 475,740 cases in Germany. CAD was diagnosed in 12,153,473 patients between 2005 and 2023, of which 78,199 cases received a CCTA scan, and 12,075,274 cases received no CCTA scan. CCTA= cardiac computed tomography angiography, CAD = coronary artery disease are scarce. In few other countries, such as Denmark, nationwide CT registry data were available. In 110,000 cases undergoing first-time CCTA in Denmark, long-term cardiovascular risk was low, if no revascularization was performed and no myocardial infarction diagnosed within 180 days after the CCTA scan [13]. Currently, CCTA cases in Germany are not systematically analyzed. The CONFIRM registry which also includes German hospitals with 18,000 patients, focusing on the prognostic values of CCTA [14, 15], whereas CONFIRM 2 is planned to quantify phenotypes of cardiovascular diseases by CCTA [16]. In the last years a German CT registry was constructed focusing on technical and procedural aspects, indications and findings of CCTA [17]. However, analyses regarding demographic or clinical aspects like main diagnosis, procedures or operations in a CCTA cohort, especially in Germany, are missing. Therefore, the purpose of our analysis was to investigate the utilization of in-hospital CCTA in Germany between 2005 and 2023, describing demographical aspects, patient characteristics, diagnoses, procedures, and changes of these aspects over time. Methods Study design This study used data and calculations from the Research Data Center of the Federal Statistical Office and Statistical Offices of the Federal States (used Destatis products: https://doi.org/10.21242/23141.2005.00.00.1.1.0 to Table 1  Baseline characteristics of CCTA cases in Germany between 2005 and 2023 CCTA Cohort N = 475,740 Age, years Sex (female) Hospital region* Urban Suburban Rural Admission by Physician Emergency Discharge Finished Finished, next hospitalization planned Transferred to another hospital Exitus Length of hospital stay 0–1 days 2–4 days 5–9 days > 9 days 72 [60, 80] 208,284 (43.8) 254,566 (59.3) 101,413 (23.6) 72,995 (17.0) 271,069 (57.0) (...truncated)