Coronary artery diseaseThree-Year Outcomes and Cost Analysis in Patients Receiving 64-Slice Computed Tomographic Coronary Angiography for Chest Pain
Section snippets
Methods
A total of 436 consecutive patients were identified who had undergone 64-slice CTCA during 1 year (June 2005 through June 2006) for a diagnosis of chest pain. Coronary CTCA was performed with a 64-slice GE LightSpeed VCT scanner (GE Healthcare, Milwaukee, Wisconsin). Patients were pretreated with an intravenous β blocker or a calcium channel blocker to achieve a heartbeat <65 beats/min. Radiation exposure averaged 12 mSv. All scans were read by an experienced reader with at least level 2
Results
Of the 436 patients, 376 patients were found to have “no significant CAD” based on computed tomographic coronary angiographic results. Of the patients who were believed on computed tomographic coronary angiogram to have “flow-limiting” CAD (60 patients), 57% (34) ended up having PCI or CABG (“true” positive scan).
Although most patients underwent CTCA as their first test, a subgroup of 78 patients (18%) underwent stress testing before computed tomography. No patient had a strongly positive
Discussion
A recent study of 100 consecutive patients undergoing 64-slice CTCA for chest pain with no previous CAD and a nondiagnostic stress test finding revealed a 90% positive predictive value in detecting obstructive CAD.2 A similar study of 145 patients comparing 64-slice CTCA with myocardial perfusion testing revealed a sensitivity of 98%, specificity of 74%, positive predictive value of 90%, and negative predictive value of 94% for CTCA. The investigators concluded that, in patients with suspected
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Cited by (27)
2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force
2016, Journal of the American College of CardiologyCitation Excerpt :For patients with coronary calcium detected by CT, the examination would require additional imaging, such as CCTA, that interrogates the coronary lumen. For patients with CP in the ED, using stenosis detection as a surrogate for ACS and ACS events, CCTA has reported high sensitivity (86%-100%) and NPV (93%-100%), although the PPV using invasive coronary angiography as the reference standard is still limited (50%-90%) (54–58). CCTA has been used to evaluate not only the severity of stenosis but also plaque characteristics associated with vulnerability and risk for events (18).
2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients with Chest Pain :A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force
2016, Journal of the American College of RadiologyCitation Excerpt :For patients with coronary calcium detected by CT, the examination would require additional imaging, such as CCTA, that interrogates the coronary lumen. For patients with CP in the ED, using stenosis detection as a surrogate for ACS and ACS events, CCTA has reported high sensitivity (86%-100%) and NPV (93%-100%), although the PPV using invasive coronary angiography as the reference standard is still limited (50%-90%) [54-58]. CCTA has been used to evaluate not only the severity of stenosis but also plaque characteristics associated with vulnerability and risk for events [18].
Prognostic Value of Coronary CT Angiography
2012, Cardiology ClinicsNoninvasive Coronary Artery Imaging: Current Clinical Applications. Cardiac Society of Australia and New Zealand Guidelines
2011, Heart Lung and CirculationCitation Excerpt :They also found that coronary CTA provided additional prognostic value to the Framingham Risk Scores (FRS), with non-obstructive CAD having a lower event rate and obstructive CAD having a higher event rate than predicted by the FRS alone. Another study of 436 symptomatic patients reported that those patients with minimal or no CAD on coronary CTA were free from events at three years of follow-up: a NPV of 100% [37]. The prevalence of CAD was 14% and they estimated significant cost savings (USD 15,300/patient) compared to conventional angiograms in their local healthcare system.
Prognostic value of cardiac computed tomography angiography: A systematic review and meta-analysis
2011, Journal of the American College of CardiologyCitation Excerpt :Twenty-one studies (14,15,23,25,28,41–56) were excluded after further review for reasons outlined in Figure 1. Eighteen studies were identified for inclusion from the literature search (7,8,10–12,16–22,24,26–30). No additional studies were identified from the references of these articles.
Quantification of coronary arterial stenoses by multidetector CT angiography in comparison with conventional angiography: Methods, caveats, and implications
2011, JACC: Cardiovascular ImagingCitation Excerpt :Recently, the assessment of coronary calcification was shown to be incremental to an ischemia score by SPECT (75). Studies in increasing numbers suggest that assessing the presence and severity of CAD, as well as the atherosclerotic plaque characteristics, using MDCT coronary angiography provides at least similar, possibly even superior prognostic information compared with SPECT and invasive coronary angiography (74,76–82). Integrating information on total coronary atherosclerotic plaque burden and number and location of stenoses, plaque characterization is likely more important than mere stenosis assessment (79).