Abstract 04: Diagnostic Accuracy of Coronary CT in Survivors of Out-Of-Hospital Circulatory Arrest: Can CT Serve as a Gatekeeper for Invasive Coronary Angiography?

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Kelley R Branch ◽  
Ravi Hira ◽  
Robin M Brusen ◽  
Charles Maynard ◽  
Medley Gatewood ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Diagnostic Accuracy ◽  
Circulatory Arrest ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Patient Level ◽  
Coronary Ct ◽  
Artery Disease

Introduction: Out-of-hospital circulatory arrest (OHCA) is commonly assumed to be from a cardiac cause although routine early invasive coronary angiography (ICA) remains controversial and has a relatively high proportion of studies without obstructive coronary artery disease (CAD). The ability of coronary CT angiography (CCTA) to detect significant CAD in OHCA survivors has not been evaluated. Methods: The prospective CT-FIRST trial enrolled 104 OHCA survivors who had an early (<6 hours from hospital arrival) head-to-pelvis CT scan that included an ECG-gated CCTA (FORCE CT, Siemens). The CCTA scanned 0-90% of the cardiac cycle without routine use of beta blockers or nitroglycerin. Treating physicians were blinded to the CCTA analysis. ICA was ordered at the discretion of treating physicians. Readers blinded to corresponding studies analyzed CCTA and ICA for coronary stenoses using a 20 segment coronary model. Obstructive CAD was assumed for >50% stenosis. Patient-level diagnostic accuracy calculations for CCTA to identify obstructive CAD used ICA as the standard. Results: Of the 104 enrolled patients, 28 (27%) had both CT and ICA. All CCTA studies were evaluable. Diagnostic accuracy data are shown in the Table. Overall, diagnostic accuracy measures were excellent between CCTA and ICA at the patient level. Conclusions: Early CCTA in OHCA survivors has high diagnostic accuracy for obstructive coronary artery disease and could be used as a gatekeeper to ICA.

Abstract 19638: A High Percentage of Patients Referred for Invasive Coronary Angiography Found to Have No Obstructive Coronary Artery Disease are Referred for Appropriate Indications

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Michelle Ouellette ◽  
Virginia Workman ◽  
Adrian Loffler ◽  
George A Beller ◽  
Jamieson M Bourque
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stress Test ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Syndrome ◽  
Obstructive Disease ◽  
Number Of Patients ◽  
Artery Disease

Introduction: The incidence of normal coronary arteries in patients referred for invasive coronary angiography (ICA) ranges from 30-60%. We sought to evaluate patterns of referral, assess the rate of appropriate catheterization and determine the prevalence of coronary artery disease (CAD) in our population by appropriateness and indication. Methods: Retrospective analysis was performed on 930 consecutive patients undergoing diagnostic ICA. Indications for ICA were reviewed and appropriate use criteria (AUC) were applied to the cohort retrospectively. Patients with known CAD, prior MI, CHF, or indication for pre-transplant workup or cardiac surgery were excluded. Rates of non-obstructive (21-49% stenosis) and obstructive CAD (≥50%) were compared by appropriateness status using Fisher’s Exact Testing. Results: Of the 930 patients studied, 55.6% were male with median age of 62 and 10-year ASCVD risk score of 17.7%. Acute coronary syndrome (ACS) was the most prevalent indication for referral (48.5%) with a 68.6% prevalence of obstructive CAD. A positive stress test was the indication in 18.9% with a 51.4% rate of obstructive CAD. The rates of the remaining referral indications are given in Figure 1. In those referred appropriately for angiography (n=923), the prevalence of obstructive disease was 55.9% (n=516), non-obstructive disease 13.6% (n=125), and normal coronaries 30.6%(n=282). Inappropriate referral was identified in only 7 patients (0.8%), all of whom had normal coronaries with p<0.001. Conclusions: At a single quaternary care academic center the majority of coronary angiographies performed invasively are appropriate by AUC. Despite adherence to AUC, there continues to be a large number of patients with no evidence of obstructive disease, including in those with ACS. Further research is needed to further refine the AUC and its role in risk stratification for obstructive CAD.

Abstract 16357: Identification of Circulating Proteins that Predict the Presence of Obstructive Coronary Artery Disease in Symptomatic, Non-Diabetic Patients Referred for Invasive Coronary Angiography

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
James Wingrove ◽  
Karen Fitch ◽  
Phil Beineke ◽  
Steven Rosenberg
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Diabetic Patients ◽  
Protein Markers ◽  
Adjusted Analysis ◽  
Major Coronary Artery ◽  
Artery Disease

Background: The diagnosis of patients presenting for the first time with typical or atypical symptoms consistent with obstructive coronary artery disease (CAD) remains challenging; despite the existence of a number of non-invasive modalities for the assessment of CAD, the yield of obstructive CAD in patients who undergo invasive coronary angiography remains low. We sought to identify circulating protein biomarkers that might aid in the diagnosis of obstructive CAD in non-diabetic patients. Methods: 386 non-diabetic patients from the PREDICT study (NCT00500617) were divided into two independent case:control sets for initial marker discovery (Set 1, n=187) and preliminary model validation (Set 2, n=199). Cases were defined as patients with ≥50% stenosis in ≥1 major coronary artery; controls had < 50% stenosis in any major coronary artery as determined by quantitative coronary angiography (QCA). In 11% of the patients QCA was not available and 70% stenosis by clinical read was used as a case threshold. 135 protein markers were evaluated in plasma from Set 1 patients using an electrochemoluminescence-based platform (MesoScale); the top markers were analyzed in Set 2 and used to develop predictive models using penalized logistic regression (LASSO). Model performance was estimated via 2500 iteration of cross validation on random holdout sets of 14 patients. Results: In a sex and age adjusted analysis, nine protein markers obtained nominal significance (p < 0.05) in Set 1, with 9 additional markers trending towards significance (p 0.7); the average of these pairs was used for subsequent analysis. Top markers were evaluated in Set 2 and a five marker (Adiponectin, ApoA1, NT-proBNP, S100A8-MPO, PlGF) model was fitted via LASSO, resulting in a mean cross-validated AUC of 0.64. Conclusion: We have identified a set of plasma protein markers in subjects referred for invasive angiography, which in age and sex adjusted analysis are responsive to the presence of obstructive CAD. Use of such protein markers alone, or in combination with other genomic markers or clinical risk factors may aid in the identification of obstructive CAD in non-acute, symptomatic patients.

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