Abstract 323: Assessment of Coronary Artery Calcium on Routine Non-gated Chest Computed Tomography to Risk Stratify Patients Presenting With Chest Pain

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Richard Vautier ◽  
Dae Hyun Lee ◽  
Yasmin Ayoubi ◽  
Paula Hernandez Burgos ◽  
Fahad Hawk ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Predictive Value ◽  
Coronary Artery Stenosis ◽  
Stress Test ◽  
Invasive Coronary Angiography ◽  
Chest Ct ◽  
Cardiac Stress ◽  
Risk Patients

Background: Coronary artery calcium (CAC) scoring is an important tool for cardiovascular risk stratification. CAC scoring in both asymptomatic and symptomatic, low-intermediate risk patients has also shown prognostic utility and has a high negative predictive value for obstructive coronary artery disease (CAD). Patients who present with chest pain frequently undergo non-gated chest computed tomography (CT) to evaluate for non-cardiac etiologies. In fact, several studies have demonstrated that a CAC score from a non-gated chest CT correlates well with a dedicated calcium-scoring CT. However, the predictive value on CAD through assessing the presence (CAC>0) or the absence of calcium (CAC=0) detected on non-gated chest CT in patients presenting with chest pain is unknown. Methods: Low-intermediate risk patients (n=92) presenting to the emergency department with chest pain who underwent non-gated chest CT and were subsequently evaluated with either a cardiac stress test or invasive coronary angiography were included. Dichotomous CAC was assessed in a blinded fashion and classified as CAC=0 or CAC>0. Obstructive CAD was defined as either: ischemia on stress testing or any coronary artery stenosis greater than 70% (left main coronary artery stenosis greater than 50%) on invasive coronary angiography. Results: CAC=0 on non-gated chest CT was found in 59.2% (n=42). Patients with CAC=0 had a significantly lower age and TIMI score compared to patients with a CAC>0. (p<0.01 ) Patients with a CAC>0 were found to more likely have obstructive CAD on subsequent testing: cardiac stress test (Likelihood ratio[LR]:6.42, p=0.022); and invasive angiography (LR:12.46, p=0.002). There were no patients with a CAC=0 that were found to have obstructive CAD on invasive coronary angiography, resulting in a 100% sensitivity and 100% negative predictive value. Conclusion: Patient who presents with chest pain frequently undergo evaluation with a non-gated chest CT to assess non-cardiac etiologies. Exclusion of CAC on non-gated chest CT may be useful as an adjunct for further risk stratification to avoid potential adverse events and cost associated with further testing.

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 Clinical judgement in chest pain: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Mishita Goel ◽  
Shubhkarman Dhillon ◽  
Sarwan Kumar ◽  
Vesna Tegeltija
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Tobacco Use ◽  
Stress Test ◽  
Artery Bypass ◽  
Pretest Probability ◽  
Clinical Judgement ◽  
Test Results ◽  
Cardiac Stress ◽  
History Of

Abstract Background Cardiac stress testing is a validated diagnostic tool to assess symptomatic patients with intermediate pretest probability of coronary artery disease (CAD). However, in some cases, the cardiac stress test may provide inconclusive results and the decision for further workup typically depends on the clinical judgement of the physician. These decisions can greatly affect patient outcomes. Case presentation We present an interesting case of a 54-year-old Caucasian male with history of tobacco use and gastroesophageal reflux disease (GERD) who presented with atypical chest pain. He had an asymptomatic electrocardiogram (EKG) stress test with intermediate probability of ischemia. Further workup with coronary computed tomography angiography (CCTA) and cardiac catheterization revealed multivessel CAD requiring a bypass surgery. In this case, the patient only had a history of tobacco use but no other significant comorbidities. He was clinically stable during his hospital stay and his testing was anticipated to be negative. However to complete workup, cardiology recommended anatomical testing with CCTA given the indeterminate EKG stress test results but the results of significant stenosis were surprising with the patient eventually requiring coronary artery bypass grafting (CABG). Conclusion As a result of the availability of multiple noninvasive diagnostic tests with almost similar sensitivities for CAD, physicians often face this dilemma of choosing the right test for optimal evaluation of chest pain in patients with intermediate pretest probability of CAD. Optimal test selection requires an individualized patient approach. Our experience with this case emphasizes the role of history taking, clinical judgement, and the risk/benefit ratio in deciding further workup when faced with inconclusive stress test results. Physicians should have a lower threshold for further workup of patients with inconclusive or even negative stress test results because of the diagnostic limitations of the test. Instead, utilizing a different, anatomical test may be more valuable. Specifically, the case established the usefulness of CCTA in cases such as this where other CAD diagnostic testing is indeterminate.

scholarly journals P1436 Diagnostic yield and accuracy of CT coronary angiography compared to invasive coronary angiography: real world data from a district general hospital in the United Kingdom

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A M Masoud ◽  
W T Topping ◽  
M L Lynch
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Predictive Value ◽  
Invasive Coronary Angiography ◽  
District General Hospital ◽  
Ct Coronary Angiography ◽  
Non Invasive ◽  
Epicardial Coronary Artery ◽  
Luminal Stenosis ◽  
Clinically Significant

Abstract Background Cost-effectiveness is imperative for a sustainable healthcare service. Non-invasive testing is used to risk stratify patients and reduce the need for invasive investigations in cardiology. The National Institute for Health and Care Excellence (NICE) Clinical Guideline for evaluation of chest pain was updated in 2016 when NICE recommended CT coronary angiography (CTCA) as the first-line investigation for patients with suspected stable coronary artery disease (CAD). Purpose To evaluate the accuracy of CTCA in real life daily practice in a district general hospital outside the strict environment of clinical trials. Methods A retrospective analysis of all CTCA studies carried out between June and December 2017 was performed. Graft studies were excluded. Potentially obstructive CAD on CTCA was defined as any luminal stenosis ≥50% of a major epicardial coronary artery. On invasive coronary angiography (ICA), clinically significant CAD was defined as a luminal stenosis of ≥50% in the left main stem or a stenosis of ≥70% of any other major epicardial coronary artery. Results Out of a total of 528 CTCA studies, 109 patients (mean age 64.2 ± 10.4; 67.9% male) showed potentially significant CAD in at least one major epicardial coronary artery. The median calcium score was 379.7 (IQR = 86-929). 61 (56%) patients had ICA, 20 (18.3%) patients had non-invasive functional coronary assessment (19 stress echocardiogram and 1 stress perfusion cardiac magnetic resonance) and 3 (2.8%) patients had both. The remaining patients were managed medically without further investigation. Correlation between potentially obstructive CAD on CTCA and clinically significant CAD on ICA showed a sensitivity of 95.8% (95% CI: 85.8%-99.5%), specificity of 68.0% (95% CI: 61.0%-74.5%), positive predictive value of 42.2% (95% CI: 37.1%-47.4%), negative predictive value of 98.5% (95% CI: 94.5%-99.6%) and overall accuracy of 73.5% (95% CI: 67.5%-78.9%). Among patients who had ICA, 21 patients (34.4%) required coronary revascularization (16 percutaneous coronary intervention and 5 coronary artery bypass grafting) and 40 (65.6%) patients were treated medically. Only 1 patient (4.3% of 23 patients) showed evidence of inducible ischemia on non-invasive functional testing. Conclusion CTCA in a real world practice has high sensitivity and high negative predictive value compared to the gold standard ICA. CTCA improved patient selection for ICA to those most likely to have significant CAD.

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.

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.

scholarly journals Diagnostic Test Squatting Stress Echocardiography and Coronary Angiography in Diagnosing Coronary Heart Disease

2017 ◽  
pp. 190-8
Author(s):  
Andy Rahman ◽  
Mefri Yanni ◽  
Masrul Syafri
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Unstable Angina ◽  
Predictive Value ◽  
Stress Echocardiography ◽  
Coronary Artery Stenosis ◽  
Non Invasive ◽  
Sensitivity Specificity

Background: In patients with significant coronary heart disease (CHD), increased preload and afterload during a squat can cause wall motion abnormalities (WMA) which can be detected on echocardiography. This study was conducted to determine the diagnostic value of stress echocardiography squatting as a non-invasive examination of a relatively simple, inexpensive, and safe in the detection of coronary artery stenosis in stable CHD and unstable angina patients.Methods: This study was a cross-sectional design. The subjects were all patients with stable CHD and unstable angina whom were treated in Instalasi Pusat Jantung Rumah Sakit Dr. M. Djamil Padang from May to July 2016. Subjects underwent squatting stress echocardiography procedures followed by coronary angiography. Diagnostic test was used to determine the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of squatting stress echocardiography.Results: The sensitivity, specificity, and accuracy of squatting echocardiography for diagnosis of CAD were 90.3%, 88.9% and 89.7%, respectively.Conclusion: Squatting stress echocardiography can be proposed as a non-invasive examination which is relatively simple, inexpensive and safe to detect coronary artery stenosis on patients with stable CHD and unstable CHD.

Coronary Artery Stenosis in High-risk Patients: 64–Section CT and Coronary Angiography—Prospective Study and Analysis of Discordance

Radiology ◽  
2009 ◽  
Vol 252 (2) ◽  
pp. 377-385 ◽  
Author(s):  
Hervé Gouya ◽  
Olivier Varenne ◽  
Ludovic Trinquart ◽  
Emmanuel Touzé ◽  
Olivier Vignaux ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Coronary Angiography ◽  
Prospective Study ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
High Risk Patients ◽  
Risk Patients

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.

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