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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Computed tomography coronary angiography as first line investigation of stable chest pain: UK reality
Session:
CO6 - Imagiologia Cardiovascular
Speaker:
Rui Azevedo Guerreiro
Congress:
CPC 2019
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rui Azevedo Guerreiro
Abstract
<p>Introduction: European Society of Cardiology (ESC) guidelines on the management of stable coronary artery disease (2013) suggest a stress test, either treadmill exercise stress test or, preferably, stress imaging test for the diagnosis of stable coronary artery disease. Computed tomography coronary angiography (CTCA), according to ESC, is reserved as an alternative or after a non-conclusive stress imaging test in a very specific group of patients within the lower range of intermediate pre-test probability. On the other hand, NICE guidelines, from United Kingdom (UK), suggests that new onset stable chest pain patients, as well as those with non-cardiac chest pain and an abnormal resting ECG, may be offered CTCA, as a diagnostic test.</p> <p> </p> <p>Purpose: Authors aim to characterise the current UK reality of investigation of stable chest pain with CTCA.</p> <p> </p> <p>Methods: Single centre, prospective audit study, including 400 consecutive patients with stable chest pain, who were referred to CTCA. Demographic, CTCA and downstream testing data were collected. Statistical analysis was performed using STATA v14.</p> <p> </p> <p>Results: 400 patients were included, with mean age of 61 ± 12.2 years, 202 (52.6%) men, with a mean BMI of 28.9 ± 6.4 kg/m<sup>2</sup>. 387 (96.8%) CTCAs were diagnostic. Coronary artery disease (CAD) was diagnosed in 229 (59.2%) patients. The CAD-RADS distribution was the following: 0 – 40.8%, 1 – 24.3%, 2 – 11.1%, 3 – 6.2%, 4 – 14.7%, 5 – 2.8% (figure 1). The mean CAD-RADS was 1.4 ± 1.6. Non-obstructive (CAD-RADS 1-2) and obstructive CAD (CAD-RADS 3-5) were present in 137 (34.3%) and in 92 (23.8%) patients, respectively. In total, 67 (16.8%) patients underwent invasive coronary angiogram (ICA) after the CTCA.</p> <p> </p> <p>Conclusion: CTCA as first line investigation of stable chest pain is feasible with >95% diagnostic scans. CTCA diagnosed obstructive CAD in 23.8% of our sample. CTCA has also allowed the diagnosis of non-obstructive CAD in 34.3% of our sample, promoting the prescription of effective secondary preventive therapies, which may not have been adequately prescribed if a stress test was performed as first line investigation.</p>
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