Abstract 4221: Cardiac Computed Tomography Angiography in the Setting of Low-Moderate Coronary Artery Disease Risk - Do Results Change Management?
CCTA is sensitive and specific for detecting CAD, but the impact on patient management and outcomes is unknown. We describe our experience with consecutive cases performed at a single CCTA centre. Coronary calcium scoring and contrast-enhanced coronary CT angiograms were performed on 114 patients using a Toshiba 64-slice scanner and standard protocols. Information on demographics, risk factors, symptomatology, prior cardiac investigations and medications was collected by questionnaire and verified by the consulting cardiologist just prior to scan performance. Scan results and management recommendations were recorded. Participants were primarily male (76.1%) with a mean age of 59.8±9.9yrs. CAD risk factor prevalence was: 53.2% hypertensive, 10.6% diabetic, 49% ever smoked, 75.7% with a family history of premature CAD, and mean LDL and HDL were 2.68±0.81 and 1.4±0.43 μmol/L. Baseline medical therapy is listed in Table I⇓. The prevalence of chest discomfort symptoms was: none (55.4%), non-cardiac (4.3%), atypical (15.2%) and typical (25.1%). Prior investigations included MPI (42.1%), and EST (53.5%) with results that were negative (50%, 45.9%) positive (35.4%, 23%) or equivocal (14.6%, 27.9% respectively). A pre-existing diagnosis of CAD was present in 21.9%. Median coronary calcium (Agatston) score was 79 ( range 0→1899). CAD was diagnosed in 71% of patients, and luminal stenosis was >50% in 70% (n=54). Management recommendations included changes to medical therapy (Table I⇓), further testing (EST (n=3), MPI (n=6), angiography (n=14)), and test cancellation (MPI (n=2)). In no patients did CCTA result in the cancellation of cardiac catheterization. CCTA provided a new diagnosis of CAD in 49% of patients of low-moderate CAD risk, and resulted in a net increase in the number of medications and investigations ordered. The impact on patient morbidity and mortality is the subject of further study.