Influence of coronary computed tomography-angiography on patient management

Jukić, Mladen and Pavić, Ladislav and Čerkez Habek, Jasna and Medaković, Petar and Delić Brkljačić, Diana and Brkljačić, Boris (2012) Influence of coronary computed tomography-angiography on patient management. Croatian Medical Journal, 53 (1). pp. 4-10. ISSN 0353-9504

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Abstract

AIM: To evaluate how coronary computed tomography-angiography (CCTA) altered the management and treatment of patients with suspected coronary artery disease (CAD). ----- METHODS: During 2009, we studied 792 consecutive patients with suspected CAD. CCTA was performed in all patients using a 64-slice dual-source CT scanner and standard scanning protocols. ----- RESULTS: After CCTA, obstructive CAD was excluded in 666 patients. During the 12-month clinical follow-up, 98.6% of these patients were free of major adverse cardiac events. Also, the indication for cardiac catheterization (CC) was revoked in 77.2% of patients. It was also revoked in all patients with low Morise pre-test risk, 80.7% with intermediate risk, and 72.6% with high risk. Medical therapy was changed in 54.7% of patients with confirmed CAD. ----- CONCLUSION: CCTA can reliably exclude significant CAD not only in patients with low and moderate risk, but also in those with high risk. It can also reliably replace CC in the majority of elective patients regardless of risk stratification. It can also be useful in risk reclassification and optimization of medical therapy in patients with CAD.

Abstract in Croatian

Utjecaj koronarne CT angiografije na postupak s pacijentima ----- Cilj Utvrditi kako koronarna CT angiografija (eng, CCTA) utječe na postupak s pacijentima koji imaju koronarnu arterijsku bolest. ----- Postupci Za vrijeme 2009., ispitali smo 792 uzastopnih pacijenata kod kojih je postojala sumnja na koronarnu arterijsku bolest. CCTA je provedena s 64-slojnim CT skenerom s dvostrukim izvorom i prema standardnim protokolima za skeniranje. ----- Rezultati Nakon CCTA, opstruktivna koronarna arterijska bolest isključena je kod 666 pacijenata. Za vrijeme kliničkog praćenja u trajanju od 12 mjeseci, 98,6% ovih pacijenata nije doživjelo ozbiljnije neželjene kardiovaskularne incidente. Također, indikacija za kardijalnu kateterizaciju povučena je kod 77,2% pacijenata, kao i kod svih pacijenata s niskim Morise pre-testnim rizikom, kod 80,7% pacijenata s umjerenim rizikom i 72,6% s visokim rizikom. Terapija je promijenjena kod 54,7% pacijenata s potvrđenom koronarnom arterijskom bolešću. ----- Zaključak CCTA može pouzdano isključiti značajnu koronarnu arterijsku bolest ne samo kod pacijenata s niskim i umjerenim rizikom, nego i kod onih s visokim rizikom. Ona također može pouzdano zamijeniti kardijalnu kateterizaciju kod većine elektivnih pacijenata s koronarnom arterijskom bolešću.

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