Diagnostic and Therapeutic Usefulness of Coronary Computed Tomography Angiography in Out-Clinic Patients Referred for Chest Pain.
Coronary computed tomography angiography (CCTA) is widely used to exclude coronary artery disease (CAD) in patients with low-to-intermediate pretest probability (PTP) of obstructive CAD. The aim of our study was to investigate the reclassification by CCTA and the implications of CCTA results on management because limited studies exist on these subjects; 1,560 patients with chest pain without a history of CAD and with low or intermediate PTP of CAD referred for CCTA from the out-patient clinic were prospectively included. PTP was defined by the Duke Clinical Score as either low (<15%), low-intermediate (15% to 50%), or high-intermediate (50% to 85%). Distribution of CCTA results among the categories of PTP of CAD and the influence of CCTA results on management were analyzed. CCTA revealed obstructive CAD in 7%, 15%, and 23% of cases, in patients with low, low-intermediate, and high-intermediate PTP, respectively; 855 of 1,031 patients (83%) with intermediate PTP of CAD showed no obstructive CAD on CCTA and were consequently reclassified. Management changes after CCTA occurred in 689 patients (44%). In 633 patients (41%), medication was altered and 135 (9%) were referred for invasive coronary angiography. Treatment with statin was initiated in 442 (28%) and stopped in 71 patients (5%). Aspirin was initiated in 192 (12%) and stopped in 139 patients (9%). In conclusion, in a routine clinical cohort, CCTA resulted in reclassification in most patients. Furthermore, our study suggests that the Duke Clinical Score overestimates the probability of obstructive CAD compared with CCTA findings. Finally, CCTA results have implications on patient management, with medication changes in 41% of patients.
Department of Cardiology, Medical Center Alkmaar, Alkmaar, The Netherlands. Electronic address: m.j.bom@mca.nl.
Michiel J
MJ
Bom
Department of Cardiology, Medical Center Alkmaar, Alkmaar, The Netherlands.
Petrus M
PM
van der Zee
Department of Cardiology, Medical Center Alkmaar, Alkmaar, The Netherlands.
Jan H
JH
Cornel
Department of Nuclear Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands.
Friso M
FM
van der Zant
Department of Nuclear Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands.
Remco J J
RJ
Knol
D000368:Aged; D015992:Body Mass Index; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors