Abstract 15349: Clinical, Therapeutic and Prognostic Implications of a Normal Coronary CT Angiography in 516 Consecutive Chest Pain Patients
Introduction: Coronary CT angiography (CCTA) is an accurate and emerging diagnostic tool for evaluation of patients suspected of having coronary artery disease (CAD). Data on downstream testing, patient management and prognosis are important to further delineate the role of CCTA in clinical practice.
Hypothesis: We hypothesized that a normal CCTA in symptomatic patients does not lead to multiple diagnostic testing, influences patient management and indicates a favorable prognosis.
Methods: Prospective observational investigation of consecutive chest pain patients (without known CAD) having a normal 64-slice dual source CCTA study (no coronary plaques) from February 2007 to April 2009. Patient use of anitplatelet and lipid lowering therapy before and after the index CCTA, the use of additional downstream diagnostic testing (stress testing, myocardial perfusion imaging and invasive coronary angiography), and the occurrence of all-cause death or non-fatal myocardial infarction was recorded from validated national registries during a median (range) follow up of 18.4 months (9–34).
Results: In 516 patients, mean age 52 ± 10 years, 63% female, the pretest likelihood of CAD was low in 36%, intermediate in 62% and high in 2% of the patients. After CCTA the number of patients receiving antiplatelet therapy decreased from 45% to 25%, p<0.001, whereas lipid lowering therapy remained unchanged. Additional testing was performed in 10 (2%) patients with low-intermediate pretest likelihood of CAD; invasive angiography in 2 patients, myocardial perfusion imaging in 3 patients, and stress testing in 5 patients. No signs of CAD/myocardial ischemia were detected in any of these patients. No patients had coronary revascularization performed during follow-up. There were no deaths or myocardial infarctions during follow-up.
Conclusions: In conclusion, in symptomatic patients of low-to-intermediate pretest likelihood of CAD, a normal CCTA study influences preventive medical therapy, indicates a low rate of subsequent diagnostic testing and predicts a good prognosis.
- © 2010 by American Heart Association, Inc.