Abstract 1910: Use of Multislice Computed Tomograph Coronary Angiography for the Management of Patients with Intermediate-Risk for Cardiovascular Events after Stress Testing
Background Stress imaging studies using myocardial perfusion techniques or echocardiogra-phy are useful for risk stratification and determination of the best management strategy for patients with suspected coronary artery disease (CAD). However, an important subgroup of these are classified to be at intermediate-risk and therefore their management must be further refined. We hypothesized that by using multislice computed tomograph angiography (CTA) a better risk-assessment could be obtained.
Methods Records of consecutive patients referred for CTA to our institution from 04/2005 to 02/2006 were reviewed. Inclusion criteria: 1. New left ventricular dysfunction (EF: 35– 49%); 2. Intermediate-risk treadmill score (−11<score<5); 3. Stress-induced moderate perfusion defect (10–20%); 4. Stress echocardiographic ischemia (wall motion abnormality < 3 segments). After the results of CTA and stress test were correlated, a recommendation for medical management or invasive angiography (ICA) was made. Clinical follow-up was obtained in all patients.
Results We studied 629 patients (Table⇓). Age was 62±15, 59% men, 57% with HTN, 65% dyslipidemia, 16% diabetes, 68% symptomatic. Ninety-one (14.5%) were sent for ICA because a stenosis of > 50% by CTA was present in a territory deemed to be ischemic by the imaging stress test. Therefore ICA was avoided in 538 cases (85.5%). Assuming costs of $800 for CTA and $3000 for ICA, $1765 per patient were saved. One MI was noted after a median follow-up of 191 days (129, 268) in a patient that had been referred to ICA.
Conclusion In a population at intermediate-risk for significant CAD after stress testing, CTA can reduce the need for invasive angiography. Through correlation between a physiologic test and an anatomical test further refinement of risk stratification is possible. This approach is safe, reliable and cost-effective. Prospective studies are needed to better define its role in the management of patients with suspected CAD.