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Diagnostic yield of coronary computed tomography angiography in symptomatic elderly patients
Session:
Painel 3 - Imagiologia Cardiovascular 2
Speaker:
Luís Graça Santos
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Posters
FP Number:
---
Authors:
Luís Graça Santos; Ricardo Ladeiras-Lopes; Nuno Dias Ferreira; Rita Faria; Wilson Ferreira; Mónica Carvalho; Pedro Braga
Abstract
<p><strong>Introduction: </strong>Coronary computed tomography angiography (cCTA) is widely considered the optimal non-invasive test to rule out coronary artery disease (CAD) and the gatekeeper for invasive coronary angiography (ICA). However, its diagnostic utility in elderly patients (pts) is less well established due to concerns regarding high coronary calcium scores (CaS), irregular/high heart rates, and breath-holding difficulties.</p> <p><strong>Aim: </strong>To investigate the diagnostic yield of cCTA in elderly pts with suspected CAD.</p> <p><strong>Methods: </strong>Single-centre retrospective study of symptomatic elderly pts (≥ 70 years) referred for cCTA to rule out CAD, between October 2017 and November 2019. Patients with known history of CAD and suspected acute coronary syndrome were excluded. Baseline demographic and clinical characteristic were collected as well as scan features and findings. A 192x2 dual-source CT equipment was used. Studies were designated as either diagnostic or non-diagnostic (≥1 non-interpretable coronary segment). Moreover, diagnostic studies were classified as normal (no plaque), non-obstructive (stenosis <50%) or obstructive CAD (≥1 stenosis ≥50%); and non-diagnostic studies were stratified according to the motive jeopardizing optimal coronary evaluation. Individuals who underwent ICA were followed in order to assess per patient cCTA accuracy (PPA) for obstructive CAD identification.</p> <p><strong>Results: </strong>A total of 207 pts were enrolled. Overall, mean age was 73±3 years and 51% were male. Baseline patient and study information is depicted in Figure 1A. A diagnostic study was obtained in 143 pts (69.1%), 35 showing obstructive CAD. Sixty-four pts (31.9%) had a non-diagnostic study, 54 of them (84.4%) due to either prohibitive CaS to undergo angiography (CaS=924.9±880.6) or calcium blooming artefacts on angiography. Still, at least one stenosis ≥50% was diagnosed in 12 pts of this group (Figure 1B). Overall, 19 pts presenting ≥1 obstructive lesion, regardless of whether the global study was conclusive, underwent ICA which confirmed obstructive CAD in 13 cases (PPA: 68.4%).</p> <p><strong>Conclusion:</strong> In this contemporary cohort of symptomatic elderly pts undergoing cCTA for suspected CAD, a high proportion of diagnostic tests was obtained and cCTA showed good accuracy for obstructive CAD recognition. Calcification was responsible for most non-diagnostic tests, but it also provides additional information regarding cardiovascular risk. According to our results, cCTA seems to be of great value in older populations.</p>
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