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Effect of Coronary Computed Tomography Angiography Disease Burden on the Incidence of Recurrent Chest Pain

Homayoun R Ahmadian1, Dustin M Thomas1, David J Shaw1

  • 1Cardiology Service MCHE-MDC, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234-6200, USA.

International Scholarly Research Notices
|June 30, 2016
PubMed

Insights

Patients with no obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA) experience fewer chest pain evaluations and repeat testing. This indicates CCTA effectively identifies low-risk patients, reducing healthcare utilization.

Area of Science:

  • Cardiovascular Imaging
  • Diagnostic Cardiology
  • Health Services Research

Background:

  • Coronary computed tomography angiography (CCTA) is increasingly used for evaluating suspected coronary artery disease (CAD).
  • Understanding post-CCTA patient management, particularly for chest pain, is crucial for optimizing healthcare resource allocation.
  • The relationship between CAD burden identified by CCTA and subsequent clinical evaluations requires further investigation.

Purpose of the Study:

  • To investigate the frequency and patterns of chest pain evaluations following an initial coronary computed tomography angiography (CCTA).
  • To assess these evaluations based on the severity of coronary artery disease (CAD) burden determined by CCTA.
  • To evaluate the rates of major adverse cardiovascular events (MACE) across different CAD severity groups.

Main Methods:

  • A cohort of 1,518 patients undergoing initial CCTA was retrospectively analyzed.
  • Patients were categorized into three groups: no CAD, nonobstructive CAD (<50% stenosis), and obstructive CAD (≥50% stenosis).
  • Subsequent chest pain evaluations, repeat testing rates, and MACE (all-cause mortality, MI, stroke, late revascularization) were tracked over 22 months.

Main Results:

  • Major adverse cardiovascular event (MACE) rates were significantly higher in patients with obstructive CAD (8.9%) compared to nonobstructive CAD (0.7%) and no CAD (1.6%).
  • Chest pain evaluations post-CCTA were more frequent in patients with obstructive CAD (17.8%) compared to nonobstructive CAD (13.9%) and no CAD (7.5%).
  • Repeat testing incidence was highest in the obstructive CAD group (67.7%), followed by nonobstructive CAD (54.9%) and no CAD (36.5%).

Conclusions:

  • Absence of obstructive CAD on initial CCTA is strongly associated with lower rates of subsequent chest pain evaluations and repeat testing.
  • Patients without obstructive CAD demonstrate low rates of major adverse cardiovascular events (MACE) during follow-up.
  • CCTA findings effectively stratify patients, guiding clinical management and potentially reducing unnecessary healthcare utilization.

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