P2719The impact of “diseased only coronary artery” invasive diagnostics strategy on contrast and radiation dose in patients with coronary artery disease following coronary computed tomography angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Debski ◽  
M Kruk ◽  
S Bujak ◽  
Z Dzielinska ◽  
M Demkow ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Radiation Dose ◽  
Contrast Media ◽  
Coronary Arteries ◽  
Coronary Computed Tomography Angiography ◽  
Contrast Volume ◽  
Diseased Vessel ◽  
Artery Disease

Abstract Background Coronary computed tomography angiography (CTA) has high diagnostic accuracy in ruling out significant stenosis of coronary arteries in patients with intermediate probability of coronary artery disease. Based on CTA result, some patients are scheduled for invasive coronary angiography (ICA). As no specyfic guidelines exist for such situations, during ICA contrast media is routinely injected into both coronary arteries, irrespectively of CTA result. Conceivably, patients scheduled for ICA with one vessel disease may benefit from invasive interrogation limited to the diseased vessel only, presumably resulting in less contrast, lower radiation dose and less complications related to catheterization. Purpose The aim of this study was to analyse the potential trade-off between the benefits and costs of a “diseased-vessel-only” (>50% DS in CTA) invasive diagnostic approach in patients undergoing ICA following coronary CTA, as compared to the traditional “total ICA” (including both arteries regardless of CTA result) approach. The potential benefits were defined as contrast and radiation doses reduction during ICA and the costs were defined as missing significant coronary stenosis. Methods In 85 patients who underwent CTA and subsequently ICA we precisely measured contrast volume and radiation dose used to visualise each vessel during ICA. Then we proposed excluding a vessel (either left or right coronary artery) without >50% diameter stenosis in CTA from ICA, and studied how it would affect ICA contrast and radiation values. DS in CTA and ICA were assessed quantitatively. Results CTA sensitivity, specificity, positive predictive value and negative predictive value in diagnosing >50%DS as assessed by ICA were 95.2%, 96.2%, 91.6% and 97.9%, respectively. Applying <50% DS in CTA as a threshold not to visualise the artery during ICA would reduce contrast volume by 47% (27ml, Fig. 1) and radiation dose by 51% (3.14mSv, Fig.2, both p<0.0001). No significant (>50%DS in ICA) stenosis would be missed by CTA. Figures 1 and 2 Conclusion These real-world data support the concept that vessels with <50%DS in CTA do not need to be visualised during ICA. Such approach would result in significant reduction in contrast media volume and patient's exposure to radiation during ICA, without underdiagnosing any of the patients.

scholarly journals Use of Coronary Computed Tomography Angiography to Screen Hospital Employees with Cardiovascular Risk Factors

2021 ◽  
Vol 18 (10) ◽  
pp. 5462
Author(s):  
Po-Yi Li ◽  
Ru-Yih Chen ◽  
Fu-Zong Wu ◽  
Guang-Yuan Mar ◽  
Ming-Ting Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Significant Risk ◽  
Coronary Computed Tomography ◽  
Hospital Employees ◽  
Artery Disease

The objective of this study was to determine how coronary computed tomography angiography (CCTA) can be employed to detect coronary artery disease in hospital employees, enabling early treatment and minimizing damage. All employees of our hospital were assessed using the Framingham Risk Score. Those with a 10-year risk of myocardial infarction or death of >10% were offered CCTA; the Coronary Artery Disease Reporting and Data System (CAD-RADS) score was the outcome. A total of 3923 hospital employees were included, and the number who had received CCTA was 309. Among these 309, 31 (10.0%) had a CAD-RADS score of 3–5, with 10 of the 31 (32.3%) requiring further cardiac catheterization; 161 (52.1%) had a score of 1–2; and 117 (37.9%) had a score of 0. In the multivariate logistic regression, only age of ≥ 55 years (p < 0.05), hypertension (p < 0.05), and hyperlipidemia (p < 0.05) were discovered to be significant risk factors for a CAD-RADS score of 3–5. Thus, regular and adequate control of chronic diseases is critical for patients, and more studies are required to be confirmed if there are more significant risk factors.

scholarly journals Prognostic value of normal and non-obstructive coronary artery disease based on CT angiography findings. A 12 month follow up study

2019 ◽  
Vol 11 (4) ◽  
pp. 318-321
Author(s):  
Amirreza Sajjadieh Khajouei ◽  
Atoosa Adibi ◽  
Zahra Maghsodi ◽  
Majid Nejati ◽  
Mohaddeseh Behjati
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Prognostic Value ◽  
Significant Finding ◽  
Cardiac Events ◽  
Luminal Narrowing ◽  
Artery Disease

Introduction: The advent of multi-slice computed tomography (CT) technology has provided a new promising tool for non-invasive assessment of the coronary arteries. However, as the prognostic outcome of patients with normal or non-significant finding on computed tomography coronary angiography (CTCA) is not well-known, this study was aimed to determine the prognostic value of CTCA in patients with either normal or non-significant CTCA findings.|<br /> Methods: This retrospective cohort study was performed on patients who were referred for CTCA to the hospital. 527 patients with known or suspected coronary artery disease (CAD), who had undergone CTCA within one year were enrolled. Among them, data of 465 patients who had normal (no stenosis, n=362) or non-significant CTCA findings (stenosis <50% of luminal narrowing, n=103) were analyzed and prevalence of cardiac risk factors and major adverse cardiac events (MACE) were compared between these groups. In addition, a correlation between these factors and the number of involved coronary arteries was also determined. <br /> Results: After a mean follow-up duration of 13.11±4.63 months, all cases were alive except for three patients who died by non-cardiac events. Prevalence of MACE was 0% and 3% in normal CTCA group and non-significant groups, respectively. There was no correlation found between the number of involved coronary arteries and the prevalence of MACE (P = 0.57). <br /> Conclusion: A normal CTCA could be associated with extremely low risk of MACE over the first year after the initial imaging, whereas non-significant obstruction in coronary arteries may be associated with a slightly higher risk of MACE.

scholarly journals Prognostic value of fat attenuation index of pericoronary adipose tissue surrounding left anterior descending artery on coronary computed tomography angiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Sugiyama ◽  
Y Kanaji ◽  
M Hoshino ◽  
M Yamaguchi ◽  
M Hada ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Adipose Tissue ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Coronary Computed Tomography Angiography ◽  
Coronary Cta ◽  
Kaplan Meier ◽  
Attenuation Index ◽  
Artery Disease

Abstract Background Recent studies reported the association between elevated fat attenuation index (FAI) of pericoronary adipose tissue (PCAT) on coronary computed tomography angiography (CTA) and worse cardiac outcomes. Purpose We investigated the prognostic value of increased FAI-defined coronary inflammation status in patients with coronary artery disease. Methods Three-hundred fifty-eight patients (127 acute coronary syndromes [ACS], 231 stable coronary artery disease) with left anterior descending artery (LAD) as a culprit vessel who underwent coronary CTA were retrospectively studied. The FAI defined as the mean CT attenuation value of PCAT (−190 to −30 Hounsfield Unit [HU]) was measured at the proximal 40-mm segment of LAD. All subjects were divided into two groups according to the median value of FAI in the LAD. The association between the incidence of major adverse cardiac events (MACE) including all-cause death, myocardial infarction, heart failure, target and non-target vessel revascularization were evaluated. Results In a total of 358 patients, median FAI values surrounding the LAD was −71.46 (interquartile range, −77.10 to −66.34) HU. Thirty-eight patients (10.6%) experienced MACE during the follow-up period (median, 818 days). Kaplan-Meier analysis revealed that high FAI-LAD (&gt;−71.46 HU [median]) was significantly associated with the incidence of MACE (log-rank test, chi-square = 4.183, P=0.041) (Figure). Conclusions In patients with coronary artery disease with culprit LAD lesions, elevated FAI of PCAT surrounding the LAD was associated with worse clinical outcomes. Assessment of FAI may have a potential for potential for non-invasive risk-stratification by coronary CTA. Kaplan-Meier analysis for MACE Funding Acknowledgement Type of funding source: None

scholarly journals Usefulness of preoperative coronary computed tomography angiography in high risk non-cardiovascular surgery old patients with unknown or suspected coronary artery disease

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xue-Ming Li ◽  
Zhong-Zhi Xu ◽  
Zhi-Peng Wen ◽  
Jiao Pei ◽  
Wei Dai ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Older Patients ◽  
Cardiovascular Surgery ◽  
Coronary Computed Tomography Angiography ◽  
Agatston Score ◽  
Artery Disease ◽  
Rule Out

Abstract Background Cumulative evidence has shown that the non-invasive modality of coronary computed tomography angiography (CCTA) has evolved as an alternative to invasive coronary angiography, which can be used to quantify plaque burden and stenosis and identify vulnerable plaque, assisting in diagnosis, prognosis and treatment. With the increasing elderly population, many patients scheduled for non-cardiovascular surgery may have concomitant coronary artery disease (CAD). The aim of this study was to investigate the usefulness of preoperative CCTA to rule out or detect significant CAD in this cohort of patients and the impact of CCTA results to clinical decision-making. Methods 841 older patients (age 69.5 ± 5.8 years, 74.6% males) with high risk non-cardiovascular surgery including 771 patients with unknown CAD and 70 patients with suspected CAD who underwent preoperative CCTA were retrospectively enrolled. Multivariate logistic regression analysis was performed to determine predictors of significant CAD and the event of cancelling scheduled surgery in patients with significant CAD. Results 677 (80.5%) patients had non-significant CAD and 164 (19.5%) patients had significant CAD. Single-, 2-, and 3- vessel disease was found in 103 (12.2%), 45 (5.4%) and 16 (1.9%) patients, respectively. Multivariate analysis demonstrated that positive ECG analysis and Agatston score were independently associated with significant CAD, and the optimal cutoff of Agatston score was 195.9. The event of cancelling scheduled surgery was increased consistently according to the severity of stenosis and number of obstructive major coronary artery. Multivariate analysis showed that the degree of stenosis was the only independent predictor for cancelling scheduled surgery. In addition, medication using at perioperative period increased consistently according to the severity of stenosis. Conclusions In older patients referred for high risk non-cardiovascular surgery, preoperative CCTA was useful to rule out or detect significant CAD and subsequently influence patient disposal. However, it might be unnecessary for patients with negative ECG and low Agatston score. Trial registration Retrospectively registered.

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