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Published on: August 28, 2018
Changes in Medical Management after Coronary CT Angiography
Vânia Mairi Naue1, Gabriel Camargo1, Letícia Roberto Sabioni1
1CDPI - Clínica de Diagnóstico por Imagem, Brazil.
Insights
Coronary computed tomography angiography (CCTA) guides cardiovascular drug treatment. Patients with obstructive coronary artery disease (CAD) showed reduced non-LDL cholesterol (NLDLC) levels after CCTA-guided treatment adjustments.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Coronary computed tomography angiography (CCTA) offers non-invasive assessment of coronary artery disease (CAD).
- The clinical impact of CCTA-derived CAD phenotyping on patient management remains under investigation.
Purpose of the Study:
- To evaluate if CCTA-based CAD phenotyping influences clinical decision-making regarding cardiovascular drug prescriptions.
- To assess the impact of CCTA-guided treatment on non-LDL cholesterol (NLDLC) levels.
Main Methods:
- Analysis of consecutive patients undergoing CCTA between 2008-2011 without prior CAD diagnosis.
- Serial NLDLC measurements were taken up to 3 months before and 3-6 months after CCTA.
Main Results:
- Of 97 patients, 42% had obstructive CAD (≥50% lesion).
- Significant NLDLC reduction (-18%, p=0.001) was observed in patients with obstructive CAD.
- Treatment intensification with cholesterol-lowering drugs correlated positively with CAD severity.
Conclusions:
- CCTA findings influenced cardiovascular treatment adjustments.
- Obstructive CAD (≥50%) identified by CCTA led to intensified clinical treatment.
Introduction:
Coronary computed tomography angiography (CCTA) allows for non-invasive coronary artery disease (CAD) phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients.
Objective:
To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non-LDL cholesterol (NLDLC) levels.
Methods:
We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after.
Results:
A total of 97 patients were included, of which 69% were men, mean age 64 ± 12 years. CCTA revealed that 18 (18%) patients had no CAD, 38 (39%) had non-obstructive (< 50%) lesions and 41 (42%) had at least one obstructive ≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p = 0.32). We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p = 0.001). We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD.
Conclusion:
Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD.
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