Introduction 2010 NICE guidelines recommend cardiac CT in patients with stable chest pain and likelihood of coronary artery disease of 10–29%. We determined use of correlative imaging to assess for coronary artery disease and subsequent revascularisation.
Methods All patients who underwent cardiac CT for chest pain assessment between September 2011 and March 2013 were identified. Those with evidence of previous revascularisation were excluded. Presence and severity of reported coronary disease was documented. Correlative cardiac imaging and revascularisation were identified from electronic patient records.
Results Of 552 chest pain patients referred for cardiac CT, 293 had calcium scoring only (CTCS), 211 had CTCS and CT Coronary Angiogram (CTCA) and 48 had CTCA only. 49 patients underwent subsequent invasive angiography (IA) (8.9% patients). 14 of those were revascularised (2.5% all patients), all with abnormal CTs: 2 had CABG and 12 percutaneous coronary intervention. Of the 35 patients not revascularised, 5 had normal CTCA and IA, 24 had positive CT and negative IA, 6 had both positive. Of the patients undergoing IA, 4 of 28 (14.3%) with a calcium score <400 were revascularised compared with 9 of the 17 (52.3%) with a calcium score >400.
Conclusions 2.5% of patients referred for cardiac CT to investigate chest pain without prior interventional treatment undergo revascularisation. Revascularisation rates in patients with a positive CTCA and a calcium score of <400 were only 14.3% compared with 52.3% in those with scores of >400. This suggests a score <400 may help reduce unnecessary IA.
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