Negative coronary CT angiography for chest pain assessment predicts low event rate in 5 years

Chong, Fei; Soon, Kean; Brown, F.; Bell, Kevin W.; Lim, Yean Leng

doi:10.1111/j.1754-9485.2011.02332.x

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…Coronary CTA has emerged in recent years as a robust firstline test for investigating CAD, especially in intermediaterisk patients without a known history of CAD. 14,15 The current study demonstrates the expanding usage of coronary CTA as the first-line cardiac test for patients presenting with stable chest pain over a 3-year period, following targeted educational sessions for PCPs at our center. Our study demonstrates value in educating PCPs regarding relatively newer imaging modalities and the potential to influence requesting practices that mirror trends in specialist care.…”

Section: Discussionmentioning

confidence: 82%

“…6,[8][9][10][11][12][13] Coronary computed tomography angiography (CTA) has emerged as a robust imaging tool with an extremely high negative predictive value for the exclusion of CAD. 14,15 Because coronary CTA directly visualizes the coronary vessels, it can also characterize the extent and severity of both non-obstructive and obstructive CAD, delineate atherosclerotic plaque composition, and identify higher risk imaging features for plaque rupture (e.g., positive remodeling or low attenuation plaque). 16 Accordingly, guidelines on the investigation of CAD have evolved significantly over the past 2 decades to reflect the advantages of coronary CTA.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Investigation Trends Among Primary Care Physicians: A Paradigm Shift

Afgani

Brenna

et al. 2022

Can Assoc Radiol J

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Objective While numerous recent guidelines support coronary computed tomography angiography (CTA) as a first-line test for stable chest pain, it remains underutilized by primary care physicians (PCPs). We aimed to evaluate cardiac investigation ordering practices following education sessions, as well as the total number of downstream tests and time to diagnosis for patients presenting with stable chest pain. Methods A retrospective chart review was completed for eligible patients assessed at the Women's College Hospital Family Practice Health Centre between 2017 and 2019 following the education sessions. The outcome measures were first-choice cardiac investigation, additional downstream testing, time from presentation to first investigation, and time to final diagnosis. Results 419 patients were included in the final analysis (74.70% female; mean age 61 ± 11 years). Coronary CTA requests by PCPs increased between 2017 and 2019 (18 vs 72 tests; P < .0001). When coronary CTA was the first-line test, patients were less likely to receive additional downstream testing when compared to those receiving other first-line investigations ( P < .0001). Coronary CTA was associated with longer time to diagnosis than stress echocardiography (47 ± 45 vs 27 ± 36 days; P = .0068) due to limited availability of coronary CTA appointment times. There was no significant difference in time to final diagnosis among the cardiac imaging modalities observed in the cohort ( P = .0623). Conclusion Utilization of coronary CTA as the first-line test for stable chest pain increased following our education sessions targeting PCPs. Coronary CTA was associated with less downstream testing compared to other non-invasive cardiac investigations.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Cardiac Investigation Trends Among Primary Care Physicians: A Paradigm Shift

Afgani

Brenna

et al. 2022

Can Assoc Radiol J

View full text Add to dashboard Cite

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“…The need to exclude acute coronary syndrome results in a large number of low risk patients undergoing extensive evaluation requiring prolonged evaluations, often with false-positive results that incur increasing cost and unnecessary invasive procedures [19]. Coronary CTA allows for rapid evaluation of patients with low to intermediate risk of having coronary disease and, when without evidence of any atherosclerosis, is associated with a low rate of major adverse coronary event in the subsequent five years, with a negative predictive value of 99% ( Figure 2) [4,11]. Coronary CTA is highly accurate for the detection of CAD [9,20] and has proven to be an excellent tool for the evaluation of patients with chest pain who have a low pre-test probability of having acute coronary syndrome [21].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with normal coronary arteries by CTA have been found to have extremely low risk of adverse coronary events in the near future [7,10]. The rate of such events in patients with low-to intermediate-probability of CAD based on clinical history with a normal coronary CTA remains low for the next five years [11], therefore allowing for more expeditious evaluation of patients in future if they return with similar complaints. What has not been evaluated, however, is how to manage patients with coronary atherosclerotic disease without significant stenosis that does not clearly warrant immediate evaluation with catheterization.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Management of Mild Coronary Atherosclerotic Disease Diagnosed with Coronary CTA in the Emergency Department

Sandler¹,

McNaughton²,

Presley³

et al. 2015

Emerg Med (Los Angel)

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Introduction: Coronary computed tomography angiography (CTA) is an excellent tool for the evaluation of chest pain in patients with a low likelihood of having acute coronary syndrome. Patients with mild coronary disease are easily identified with coronary CTA in contrast to imaging studies that detect only hemodynamically significant stenosis. This study was designed to evaluate 1) the incidence mild coronary artery disease diagnosed by CTA and 2) the challenge of managing these patients in the emergency department setting. Methods: A retrospective review was performed of coronary CTA examinations requested by ED physicians over three years. Imaging results were stratified as being negative, representing mild disease, and representing moderate to severe disease. Patients with mild disease were further evaluated to determine if the patient 1) had known CAD prior to the CTA, 2) was on or was prescribed a statin, 3) had a positive family history, 4) had a smoking history, 5) was diabetic, and 6) was scheduled for follow-up with Cardiology following discharge from the ED. Results: A total of 140 coronary CTA examinations were performed on patients in the Emergency Department over a three-year period, with 137 meeting inclusion criteria. Of these, 109 studies were negative for coronary artery disease, 8 had significant CAD with greater than 50% luminal narrowing, and 20 demonstrated mild CAD without significant stenosis (age range 41-65 years with mean age of 50.2). Conclusion: Coronary CT angiography is highly accurate for the detection of coronary artery disease and has proven to be an excellent tool for the evaluation of patients with chest pain and a low pre-test probability of having acute coronary syndrome. Patients diagnosed with mild disease present a challenge to emergency department physicians as they do not require immediate intervention, but can benefit greatly from therapies designed to prevent future coronary events.

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Patient Selection: When to Use Cardiac CT Versus Other Imaging or Non-imaging Tests

Surányi

Varga-Szemes

Bradshaw

et al. 2019

Contemporary Medical Imaging

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Negative coronary CT angiography for chest pain assessment predicts low event rate in 5 years

Abstract: A negative coronary CTA in patients with a low or intermediate pretest probability for significant coronary artery disease predicts a low rate of major cardiovascular events within a 5-year period.

Cited by 5 publications

References 10 publications

Cardiac Investigation Trends Among Primary Care Physicians: A Paradigm Shift

Cardiac Investigation Trends Among Primary Care Physicians: A Paradigm Shift

Incidence and Management of Mild Coronary Atherosclerotic Disease Diagnosed with Coronary CTA in the Emergency Department

Patient Selection: When to Use Cardiac CT Versus Other Imaging or Non-imaging Tests

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