title: The value of CT cardiac angiography and CT calcium score testing in a modern cardiology service in New Zealand: a report of a single centre eight-year experience from 5,237 outpatient procedures.
abstract: BACKGROUND
  Computed tomographic (CT) cardiac angiography is of increasing value in several areas of patient management in cardiology. We assessed the ability of CT cardiac angiography to effectively 'rule out' severe coronary stenoses in patients presenting with 'atypical' symptoms and/or an equivocal stress test, which offers a new approach to the management of coronary artery disease. We also examined the use of the CT calcium score test in cardiovascular (CVS) risk assessment.
  
  
  METHODS
  From a large single centre (Mercy Hospital) in Auckland, using a prospectively acquired, comprehensive database, we audited the entire eight-year experience of 5,169 patients (7/8/06 to 31/1/14) who underwent 5,237 64-slice computed tomographic (CT) cardiac angiogram or CT calcium score tests (GE Lightspeed scanner).
  
  
  RESULTS
  From 5,169 patients there were 5,237 CT procedures. The mean patient age was 57 (SD 10) years; 42% patients were female. Of the 3,603 (69%) full CT cardiac angiogram scans, 3,509 (67%) included a calcium score test. One thousand four hundred and eighty-three (28%) of scans were a calcium score test only. Of the 3,603 (69%) full CT cardiac angiogram scans, it was possible to 'rule out' significant coronary atheroma (stenosis ≥50%) in 2,947 (82%) of these procedures. Of the 4,903 (94%) patients who had a CT calcium score test, in whom we could calculate the NZ Framingham-based CVS risk, it was possible to reassign 532 (22%) of these patients who were previously thought to be at 'low risk' to be at a higher CVS risk.
  
  
  CONCLUSIONS
  CT cardiac angiography has become established in the modern management of cardiology patients. It has particular value as a tool to 'rule out' severe coronary stenoses, and as a tool to give a more accurate assessment of CVS risk. It adds significant value to the care of many patients within an established cardiology practice.
authors.affiliation: Cardiology Department, Greenlane Cardiovascular Services, Auckland City Hospital, Auckland.
authors.forename: Chris
authors.initials: C
authors.lastname: Ellis
authors.affiliation: Department of Medicine, University of Auckland, Auckland.
authors.forename: Greg
authors.initials: G
authors.lastname: Gamble
authors.affiliation: Department of Cardiology, North Shore Hospital, Auckland.
authors.forename: Colin
authors.initials: C
authors.lastname: Edwards
authors.affiliation: Department of Cardiology, Middlemore Hospital, Auckland.
authors.forename: Niels
authors.initials: N
authors.lastname: van Pelt
authors.affiliation: Department of Cardiology, Middlemore Hospital, Auckland.
authors.forename: Ruvin
authors.initials: R
authors.lastname: Gabriel
authors.affiliation: Department of Cardiology, Greenlane Cardiovascular Services, Auckland City Hospital, Auckland.
authors.forename: Boris
authors.initials: B
authors.lastname: Lowe
authors.affiliation: Department of Cardiology, North Shore Hospital, Auckland.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Christiansen
authors.affiliation: Department of Cardiology, North Shore Hospital, Auckland.
authors.forename: Andrew
authors.initials: A
authors.lastname: To
authors.affiliation: Auckland Heart Group, Auckland.
authors.forename: Helen
authors.initials: H
authors.lastname: Winch
authors.affiliation: Department of Radiology, Mercy Hospital, Auckland.
authors.forename: Mark
authors.initials: M
authors.lastname: Osborne
authors.affiliation: Department of Cardiology, Greenlane Cardiovascular Services, Auckland City Hospital and Mercy Angiography, Auckland.
authors.forename: John
authors.initials: J
authors.lastname: Ormiston
authors.affiliation: Cardiology Department, Greenlane Cardiovascular Services, Auckland City Hospital, Auckland.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Legget
mesh_terms: D002114:Calcinosis / Q000175:diagnosis* / Q000378:metabolism; D002118:Calcium / Q000378:metabolism*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000378:metabolism; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009520:New Zealand; D010045:Outpatients; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods
chemical_list: D002118:Calcium