scholarly journals Safety and Efficacy of Computer Tomography Coronary Angiography in a Remote Centre for Outpatients Otherwise Requiring Invasive Coronary Angiography for Chest Pain Assessment

2019 ◽  
Vol 28 ◽  
pp. S8-S9
Author(s):  
Vindhya Wilson ◽  
Kerryanne Johnson
Keyword(s):  
Chest Pain ◽  
Coronary Angiography ◽  
Computer Tomography ◽  
Pain Assessment ◽  
Invasive Coronary Angiography ◽  
Safety And Efficacy

scholarly journals Invasive Coronary Angiography after Chest Pain Presentations to Emergency Departments

2020 ◽  
Vol 17 (24) ◽  
pp. 9502
Author(s):  
Frank M. Sanfilippo ◽  
Graham S. Hillis ◽  
Jamie M. Rankin ◽  
Donald Latchem ◽  
Carl J. Schultz ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Angiography ◽  
Emergency Departments ◽  
Invasive Coronary Angiography ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Discharge Diagnosis ◽  
Coronary Syndrome ◽  
Interhospital Transfer ◽  
And Gender

We investigated patients presenting to emergency departments (EDs) with chest pain to identify factors that influence the use of invasive coronary angiography (ICA). Using linked ED, hospitalisations, death and cardiac biomarker data, we identified people aged 20 years and over who presented with chest pain to tertiary public hospital EDs in Western Australia from 1 January 2016 to 31 March 2017 (ED chest pain cohort). We report patient characteristics, ED discharge diagnosis, pathways to ICA, ICA within 90 days, troponin test results, and gender differences. Associations were examined with the Pearson Chi-squared test and multivariate logistic regression. There were 16,974 people in the ED chest pain cohort, with a mean age of 55.6 years and 50.7% males, accounting for 20,131 ED presentations. Acute coronary syndrome was the ED discharge diagnosis in 10.4% of presentations. ED pathways were: discharged home (57.5%); hospitalisation (41.7%); interhospital transfer (0.4%); and died in ED (0.03%)/inpatients (0.3%). There were 1546 (9.1%) ICAs performed within 90 days of the first ED chest pain visit, of which 59 visits (3.8%) had no troponin tests and 565 visits (36.6%) had normal troponin. ICAs were performed in more men than women (12.3% vs. 6.1%, p < 0.0001; adjusted OR 1.89, 95% CI 1.65, 2.18), and mostly within 7 days. Equal numbers of males and females present with chest pain to tertiary hospital EDs, but men are twice as likely to get ICA. Over one-third of ICAs occur in those with normal troponin levels, indicating that further investigation is required to determine risk profile, outcomes and cost effectiveness.

Relative clinical value of coronary computed tomography and stress echocardiography-guided management of stable chest pain patients: a propensity-matched analysis

2020 ◽  
Author(s):  
Anastasia Vamvakidou ◽  
Oleksandr Danylenko ◽  
Jiwan Pradhan ◽  
Mihir Kelshiker ◽  
Timothy Jones ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Coronary Angiography ◽  
Stress Echocardiography ◽  
Invasive Coronary Angiography ◽  
Low Risk ◽  
Clinical Value ◽  
Coronary Computed Tomography ◽  
Stable Chest Pain

Abstract Aims The European Society of Cardiology recommends coronary computed tomography (CCT) for the assessment of low-risk patients with suspected stable angina. We aimed to assess in a real-life setting the relative clinical value of stress echocardiography (SE)- and CCT-guided management in this population. Methods and results Patients with stable chest pain and no prior history of coronary artery disease (CAD) who underwent CCT or SE as the initial investigative strategy were propensity-matched (990 patients each group-age: 59 ± 13.2 years, males: 47.9%) to account for baseline differences in cardiovascular risk factors. Inconclusive tests were 6% vs. 3% (P &lt; 0.005) in CCT vs. SE. Severe (≥70% stenosis) on CCT and inducible ischaemia on SE detected obstructive CAD by invasive coronary angiography in 63% vs. 57% patients (P = 0.33). Over the follow-up period (median 717, interquartile range 93–1069 days) more patients underwent invasive coronary angiography (21.5% vs. 7.3%, P &lt; 0.005), revascularization (7.3% vs. 3.5%, P &lt; 0.005), further functional testing 33.4% vs. 8.7% (P &lt; 0.005), but more patients were prescribed statins 8.8% vs. 3.8% (P &lt; 0.005) in the CCT vs. the SE arm, respectively. Combined all-cause mortality and acute myocardial infarction was low—CCT-2.3% and SE-3.3%—with no significant difference (P = 0.16). Conclusion Initial SE-guided management was similar for the detection of obstructive CAD, demonstrated better resource utilization, but was associated with reduced prescription of statins although with no difference in medium-term outcome compared to CCT in this very low-risk population. However, a randomized study with longer follow-up is needed to confirm the clinical value of our findings.

Abstract 1631: Exclusion of Coronary Artery Stenosis by Non-invasive Coronary Angiography Using Multislice Computed Tomography Determines a Good Long-term Prognosis in Patients With Chest Pain - Follow-Up Study in 1017 Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Peter Steinbigler ◽  
Eike Böhme ◽  
Carla Weber ◽  
Andreas Czernik ◽  
Jürgen Buck ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Multislice Computed Tomography ◽  
Coronary Artery Stenosis ◽  
Invasive Coronary Angiography ◽  
Artery Stenosis ◽  
Noninvasive Coronary Angiography

Long-term prognosis following exclusion of coronary artery stenosis by noninvasive coronary angiography using multislice computed tomography (MSCT) up to now has not been determined. We therefore performed noninvasive coronary angiography using MSCT (Philips Brilliance, 4 – 64 slices, retrospective ECG gating, 0.625mm collimation, 0.4sec gantry rotation time) in 1017 consecutive patients (657 male, 360 female, age 64±11years, 240 patients with known coronary artery disease (CAD)) referred to MSCT-study with chest pain. Patients with acute coronary syndromes, stents, atrial fibrillation and calcium scores > 1500 were not included. Based on MSCT results invasive study was recommended or not. All patients or the referring clinician were contacted by telephone or mail at least 6 months after their scan. Diagnostic image quality could be obtained in 992/1017 (98%) patients. In 620 of 992 patients (=63%) coronary artery stenosis could be excluded and invasive study was not recommended. Despite these recommendations invasive study was performed due to other clinical indications in 83/620 patients within < 30 days and in 43/537 patients within > 30days after the scan. Only in 13/126 patients stenoses >50% were found but no treatment was necessary. During the mean follow-up period of 612±192days 7/620 patients died but no patient suffered from cardiac death or acute myocardial infarction. In 372 of 992 patients invasive coronary angiography was recommended and performed in 230 patients (n=167 within < 30days, n=63 within >30days). In 165/230 patients stenoses >50% were found, treated by angioplasty or stents in 139/165 patients. During the mean follow-up period of 602±161days 11/372 patients died, two patients suffered from sudden, two patients from non-sudden cardiac death and one patient survived acute myocardial infarction. Thus, exclusion of coronary artery stenoses by noninvasive coronary angiography using multislice computed tomography determines a good lomg-term prognosis in patients with chest pain.

scholarly journals COMPARATIVE STUDY OF TREADMILL STRESS TEST(TMT) WITH INVASIVE CORONARY ANGIOGRAPHY (CAG) IN PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE

2020 ◽  
pp. 21-24
Author(s):  
Ameta Deepak ◽  
Sharma Mukesh ◽  
Singh Pal Shalinder ◽  
Yadav Sushil
Keyword(s):  
Chest Pain ◽  
Coronary Angiography ◽  
Stress Test ◽  
Invasive Coronary Angiography ◽  
Suspected Coronary Artery Disease ◽  
Atypical Chest Pain ◽  
Obstructive Lesion ◽  
Important Diagnostic Tool ◽  
Treadmill Stress Test ◽  
Treadmill Stress

Background- There are few studies which compared invasive coronary angiography (CAG) in patients presenting with chest pain (atypical, probably ischemic) in outpatient department with negative or inconclusive treadmill stress test (TMT). Objective- To assess CAG findings in patient with suspected iscemic chest pain, with negative or inconclusive TMT. Methods- Patients with chest pain (atypical, probably ischemic) underwent TMT and classified as TMT negative or inconclusive. These patients underwent CAG and findings were analysed. Results - 50 patients completed the study protocol. Of these 50 patients who underwent TMT, 31 (62%) were TMT negative and 19 (38%) were TMT inconclusive. In TMT negative group CAG showed obstructive lesion in 6(19.4%), and non obstructive lesion in 25(80.6%). In TMT inconclusive group CAG showed obstructive lesion in 11(57.8%), while non obstructive lesion in 8(42.2%). Conclusion-In patients with atypical chest pain with negative or inconclusive TMT with suspicion of coronary ischemia CAG provides an important diagnostic tool for assessing, especially with TMT inconclusive group.

CT coronary angiography in Selected Group of patients with Chest pain of new onset predicts and prevents hospital admissions & Outpatient Clinic referrals

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Cameron ◽  
I Wang ◽  
E Ashikodi ◽  
N Dhir ◽  
Y Raja ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Hospital Admissions ◽  
Invasive Coronary Angiography ◽  
Outpatient Clinics ◽  
Coronary Angiogram ◽  
Artery Disease ◽  
Ct Coronary Angiogram

Abstract Funding Acknowledgements Type of funding sources: None. Introduction NICE (National Institute of Clinical Excellence) guidelines currently recommend the use of CT coronary Angiogram (CTCA) as the initial test to investigate coronary artery disease in patients with new onset of chest pain. Our aim was to evaluate the relationship between the CT coronary angiogram findings on index presentation, and hospital admissions and re-referral to outpatient clinics in following 2 years. Method Data was accrued via a retrospective analysis of electronic medical records at Sunderland Royal Hospital pertaining to patients who presented to the Rapid Access Chest Pain Clinic (RACPC) and underwent CTCA in 2017.Data included: Presentation – Typical & atypical angina Risk factors profile Investigations including ECG, ECHO, CTCA, perfusion scan and invasive coronary angiography Severity of coronary artery lesion on CTCA Hospital admissions or re-referral to outpatient clinics in 2 year follow up Results In the 235 patients studied, mean age was 56 years with 130 (55.5%) men and 195 (82.9%) presented with atypical angina as shown in table. Out of 195 patients with atypical chest pain only 17 (8.7%) were diabetics and most of them 178 (91%) had Coronary Calcium score of 1-400. Most patients (184) underwent CT coronary angiogram with 39 (21%) having normal coronary arteries, 126 (68%) with mild to moderate coronary artery disease and 19 (11%) with severe coronary artery disease. Subsequent assessments with invasive coronary angiography, myocardial perfusion scan and Treadmill exercise did not reveal significant disease warranting coronary revascularization. Patients with normal or mild -moderate CAD on CTCA 24 (15%) represented with acute chest pain (only one needed PCI) and 6 (3.5%) were referred to outpatient clinics over 2 years follow up. In patients with severe CAD on CTCA, 6 (32%) presented with acute chest pain and 4 (21%) needed PCI. Almost all patients were treated with statins and antiplatelets following CTCA results. Conclusion CT coronary angiography is sensitive and specific in assessment of hemodynamically significant coronary artery disease in non-diabetic patients presenting with angina in outpatient setting. CTCA in patients with normal or mild to moderate CAD also gives confidence to the clinician and prevents further un-necessary investigation and hospital admissions/outpatient referrals.

scholarly journals Sex-based inequalities in contemporary UK hospital management of stable chest pain

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001672
Author(s):  
Gareth Morgan-Hughes ◽  
Michelle Claire Williams ◽  
Margaret Loudon ◽  
Carl A Roobottom ◽  
Stelios Iacovides ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Communication Systems ◽  
Invasive Coronary Angiography ◽  
Normal Coronary Arteries ◽  
Recent Onset ◽  
Computed Tomographic ◽  
Stable Chest Pain ◽  
Computed Tomographic Coronary Angiography

ObjectiveWe surveyed UK practice of National Institute for Health and Care Excellence (NICE) “Recent onset chest pain” guidance (CG95, 2016), stratified by sex. We looked for sex-related differences in referral to computed tomographic coronary angiography (CTCA) and subsequent functional imaging (FI), invasive coronary angiography (ICA) and revascularisation.MethodsThis was a prospective analysis of CTCA practice in 8 UK centres between 2018 and 2020. Coronary artery disease (CAD) was recorded with the CAD-reporting and data system. Local electronic records/archiving/communication systems were used to collect data regarding subsequent FI, ICA and revascularisation.Results2301 women, 2326 men underwent CTCA; women were older (58±11 vs 55±12 years, p<0.001) but more likely to have normal coronary arteries (46% (1047) vs 29% (685); p<0.001) and less likely to have severe stenosis (7% (169) vs 13% (307); p<0.001). FI was used less for 4% (93) women, 5% (108) men; ICA was also used less for women (8% (182) vs 14% (321)), as was revascularisation (4% (83) vs 8% (177), p<0.001 for all), including those with ≥moderate CTCA stenosis undergoing ICA (53% (79) vs 61% (166); p<0.001).ConclusionsWomen referred for a NICE CG95 (2016) CTCA are more likely to have normal coronary arteries and men more likely to have CAD. More men than women will then undergo ICA and revascularisation even after adjustments for CTCA disease severity. Raised awareness of these inequalities may improve contemporary chest pain care.

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