title: Potential for coronary CT angiography to tailor medical therapy beyond preventive guideline-based recommendations: insights from the ROMICAT I trial.
abstract: BACKGROUND
  Coronary CT angiography (CCTA) is used in the emergency department to rule out acute coronary syndrome in low-intermediate risk patients.
  
  
  OBJECTIVE
  We evaluated the potential of CCTA to tailor aspirin (ASA) and statin therapy in acute chest pain patients.
  
  
  METHODS
  We included all patients in the ROMICAT I trial who underwent CCTA before admission. Results of CCTA were blinded to caretakers. We documented ASA and statin therapy at admission and discharge and determined change in medications during hospitalization, agreement of discharge medications with contemporaneous guidelines, and agreement with the presence and severity of coronary artery disease (CAD) as determined by CCTA.
  
  
  RESULTS
  We included 368 patients (53 ± 12 years; 61% male). Baseline medical therapy at presentation included 27% on ASA and 24% on statin. Most patients who qualified for secondary prevention were on ASA and statin therapy at discharge (95% and 80%, respectively), whereas among those qualifying for primary prevention therapy, only 59% of patients were on aspirin and 33% were on statin at discharge. Excluding secondary prevention patients, among those with CCTA-detected CAD, only 66/131 (50%) were on ASA at discharge and only 53/131 (40%) were on statin. Conversely, in those without CCTA-detected CAD, 54/156 (35%) were on ASA and 20/151 (13%) were on statin at discharge.
  
  
  CONCLUSIONS
  There are significant discrepancies between discharge prescription of statin and ASA with the presence and extent of CAD. CCTA presents an efficient opportunity to tailor medical therapy to CAD in patients undergoing CCTA as part of their acute chest pain evaluation.
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA; Cardiology Division, Evanston Hospital, Walgreen Building 3rd Floor, 2650 Ridge Ave, Evanston, IL 60201, USA. Electronic address: apursnani@northshore.org.
authors.forename: Amit
authors.initials: A
authors.lastname: Pursnani
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Schlett
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mayrhofer
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA.
authors.forename: Csilla
authors.initials: C
authors.lastname: Celeng
authors.affiliation: Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Pearl
authors.initials: P
authors.lastname: Zakroysky
authors.affiliation: Department of Clinical Radiology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Nagurney
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, NY, USA.
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D001900:Boston; D017023:Coronary Angiography / Q000379:methods* / Q000592:standards; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000592:standards; D055502:Secondary Prevention / Q000592:standards; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000592:standards
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Aspirin; Coronary CT angiography; Coronary artery disease; Guidelines; Prevention; Statin
references.citation: J Thorac Imaging. 2012 Sep;27(5):289-95
references.pmid: 22914122
references.citation: Circulation. 2002 Dec 17;106(25):3143-421
references.pmid: 12485966
references.citation: Circ Cardiovasc Qual Outcomes. 2010 Nov;3(6):632-41
references.pmid: 20923997
references.citation: J Am Coll Cardiol. 2004 Aug 4;44(3):720-32
references.pmid: 15358046
references.citation: Circulation. 2011 Nov 29;124(22):2458-73
references.pmid: 22052934
references.citation: J Am Coll Cardiol. 2011 Sep 27;58(14):1414-22
references.pmid: 21939822
references.citation: J Am Coll Cardiol. 2011 Jun 14;57(24):2426-36
references.pmid: 21658564
references.citation: JACC Cardiovasc Imaging. 2011 May;4(5):481-91
references.pmid: 21565735
references.citation: Circ Cardiovasc Imaging. 2014 Jul;7(4):629-38
references.pmid: 24906356
references.citation: J Am Coll Cardiol. 2009 Feb 17;53(7):623-632
references.pmid: 19215839
references.citation: N Engl J Med. 2008 Nov 27;359(22):2324-36
references.pmid: 19038879
references.citation: J Am Coll Cardiol. 2008 Nov 18;52(21):1724-32
references.pmid: 19007693
references.citation: Circulation. 2002 Jul 16;106(3):388-91
references.pmid: 12119259
references.citation: Ann Intern Med. 2002 Jan 15;136(2):157-60
references.pmid: 11790071
references.citation: Am J Cardiol. 2009 Oct 1;104(7):873-7
references.pmid: 19766749
references.citation: J Am Coll Cardiol. 2008 Apr 8;51(14):1337-41
references.pmid: 18387433
references.citation: Ann Intern Med. 2002 Jan 15;136(2):161-72
references.pmid: 11790072
references.citation: Arch Intern Med. 2011 Jul 25;171(14):1260-8
references.pmid: 21606093
references.citation: Circulation. 2008 Jan 15;117(2):296-329
references.pmid: 18071078
references.citation: Circulation. 2006 May 16;113(19):2363-72
references.pmid: 16702489
references.citation: Circulation. 2007 Aug 14;116(7):e148-304
references.pmid: 17679616
references.citation: J Am Coll Cardiol. 2011 Mar 8;57(10):1237-47
references.pmid: 21145688
references.citation: J Am Coll Cardiol. 2005 Jul 5;46(1):166-72
references.pmid: 15992652
references.citation: J Am Coll Cardiol. 2012 Jan 31;59(5):462-74
references.pmid: 22281249
references.citation: Circ Cardiovasc Qual Outcomes. 2014 May;7(3):453-60
references.pmid: 24803472
references.citation: J Am Coll Cardiol. 2009 May 5;53(18):1642-50
references.pmid: 19406338
references.citation: Circ Cardiovasc Imaging. 2011 Sep;4(5):463-72
references.pmid: 21730027
references.citation: N Engl J Med. 2012 Jul 26;367(4):299-308
references.pmid: 22830462
references.citation: Diabetes Care. 2004 Jan;27 Suppl 1:S72-3
references.pmid: 14693931
references.citation: Circ Cardiovasc Imaging. 2011 Jan;4(1):16-23
references.pmid: 20884832
references.citation: JACC Cardiovasc Imaging. 2013 May;6(5):574-81
references.pmid: 23582355
references.citation: Am J Cardiol. 2011 Jan;107(1):10-6
references.pmid: 21146679
references.citation: J Am Coll Cardiol. 2008 Oct 14;52(16):1335-43
references.pmid: 18929245
references.citation: J Am Coll Cardiol. 2007 Sep 18;50(12):1161-70
references.pmid: 17868808
references.citation: J Am Coll Cardiol. 2007 Jan 2;49(1):62-70
references.pmid: 17207724