Coronary artery diseaseUtility of Cardiac Computed Tomography Angiography to Exclude Clinically Significant Obstructive Coronary Artery Disease in Patients After Myocardial Perfusion Imaging
Section snippets
Methods
Consecutive cases involving patients with abnormal or equivocal MPI scans who were referred for CCTA from December 2006 to September 2009 were reviewed. Inclusion criteria were age >40 years and the presence of atypical symptoms with ≥2 cardiac risk factors (hypertension, dyslipidemia, tobacco abuse, obesity, diabetes, and physical inactivity). These patients had to be referred specifically stated to be in lieu of diagnostic angiography. Patients with histories of myocardial infarction or of
Results
A total of 241 patients underwent CCTA for equivocal or abnormal findings on nuclear scans. Fifty-two percent of the cohort (126 of 241) were men, and the average age was 66 ± 11 years. Of the 241 studies performed (Table 1), 55 revealed normal coronary arteries, 97 showed minimal disease (<30%), 23 showed mild disease (30% to 50% stenosis), and 66 showed obstructive disease (>50% stenosis). Overall, 63% of patients with abnormal or equivocal findings on nuclear tests were demonstrated to have
Discussion
In the United States, slightly more than 1/3 of patients without known disease who underwent elective cardiac catheterization had obstructive CAD.6 This is similar to our present study, in which only 27% of participants had obstructive disease after equivocal or abnormal findings on nuclear tests. This study shows that using CCTA after equivocal or abnormal results on nuclear stress testing leads to a robust reduction in the need for cardiac catheterization, proving to be safe and cost
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The lack of obstructive coronary artery disease on coronary CT angiography safely reduces downstream cost and resource utilization during subsequent chest pain presentations
2015, Journal of Cardiovascular Computed TomographyCitation Excerpt :Coronary CT angiography (CCTA) has emerged as an effective tool for both outpatient and emergency department (ED) evaluation of low to intermediate risk symptomatic patients.1–6 CCTA has also been shown effective as a complementary test in patients with equivocal or abnormal noninvasive testing.7 With a high negative predictive value (∼99%) for excluding obstructive coronary stenosis, CCTA allows for both a safe and rapid disposition of patients with potential cost savings in the ED setting.8,9
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