Abstract 15941: A Strategy of Optimized Medical Management and Selective “Downstream” Procedures Following Cardiac CT Results in Extremely Low Cardiac Event Rate and All-Cause Mortality
Background: Prior studies have consistently demonstrated increased mortality in patients that have elevated coronary artery calcium (CAC) scores or those that have more severe stenoses on coronary CTA. Whether clinical management based on these tests actually leads to a substantial reduction in mortality is unknown.
Methods: We retrospectively analyzed 714 patients (55 ± 13 yrs, male = 63%) without known CAD from a single medical practice who underwent coronary CTA and CAC scanning. Patients were followed for a mean of 2.9 ± 1 yrs. All changes in medications, coronary risk factors (including lipid profiles), downstream testing, revascularization procedures, cardiac events (myocardial infarction and cardiac death), and all-cause mortality were recorded.
Results: Patients with higher CAC scores and more severe stenoses on coronary CTA received more intensive medical therapy (Table). In these patients, the use of statins and aspirin was increased and the mean LDL decrease was greater. Stress testing was primarily reserved for patients with at least one stenosis >50%. Coronary catheterization and revascularization was primarily reserved for those with a >70% stenosis, usually following stress testing. During follow-up, there were two non-cardiac deaths and no cardiac events. The elevated event rate in patients with moderate or severe plaque burden (CAC > 100) that has been reported in the literature in other populations was not observed in our patients.
Conclusions: In a population without known CAD, a treatment strategy that targets patients based on cardiac CT findings, and which includes medical therapy, stress testing, and revascularization, results in an extremely low cardiac event rate and all-cause mortality over an ∼3yr follow-up.
- © 2010 by American Heart Association, Inc.