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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Referral patterns and findings of patients undergoing CT coronary angiography
Omar K Al-Saaidi1, Saleh Baawain2, Malik Al Ghafri3
1Directorate of Nursing, Sultan Qaboos University Hospital, Muscat, Oman.
Insights
Computed tomography coronary angiography (CTCA) is valuable for diagnosing coronary artery disease, but is sometimes overused. This study found CTCA effectively triages patients, though often requested for non-chest pain symptoms.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Computed tomography coronary angiography (CTCA) is a key tool for ruling out coronary artery disease in patients with chest pain.
- International guidelines support CTCA use, yet indiscriminate application is a concern.
Purpose of the Study:
- To analyze CTCA requesting patterns and patient outcomes at Sultan Qaboos University Hospital.
- To determine the prevalence of coronary anomalies identified through CTCA.
Main Methods:
- Retrospective analysis of 1000 CTCA scans performed between 2019 and 2023.
- Data extracted from electronic patient records, including indications, findings, and subsequent procedures.
- Statistical analysis using percentages and means ± standard deviation.
Main Results:
- Chest pain was the primary indication (67.2%) for CTCA; other indications included breathlessness (19.8%) and palpitations (11%).
- Prevalence of coronary anomalies: 83.5% right dominance, 9.2% left dominance, 2.5% abnormal origins, and 2.7% aneurysmal/ectatic vessels.
- 13.1% of patients underwent invasive angiography, with 7.7% showing significant disease requiring intervention.
Conclusions:
- CTCA is frequently requested for reasons beyond chest pain.
- CTCA aids in patient triage, leading to a small proportion requiring invasive procedures.
- The study highlights CTCA's role in managing suspected coronary artery disease.
Background:
Computed tomography coronary angiography (CTCA) is widely used to rule out significant coronary artery disease in patients who present with chest pain, with many international guidelines recommending its use. However, there is a tendency for it to be used indiscriminately.
Objectives:
This study aimed to evaluate the requesting patterns of CTCA at our institution and the outcomes of these patients. We also aimed to study the prevalence of coronary anomalies observed in these patients.
Methodology:
This was a retrospective study of patients who had undergone a CTCA at Sultan Qaboos University Hospital, Muscat, over 5 years (2019-2023). Information was obtained from the electronic patient records. Data are presented as a number (percentage) or mean ± standard deviation as appropriate.
Results:
The CTCAs of 1000 patients (mean age, 51.1 + 13.5 years; 606 or 60.6% male) were analyzed. Chest pain was the main indication for requesting CTCA in 670 patients (67.2%), with breathlessness and palpitations as the other indications in 198 (19.8%) and 110 (11%) patients, respectively. Of the findings, 835 (83.5%) patients had right dominance, 92 (9.2%) had left dominance, and the remainder were co-dominant. Of the congenital abnormalities noted, 25 (2.5%) had abnormal origins (right coronary artery 9, circumflex 9), and 27 had aneurysmal or ectatic vessels. One hundred and fifty-two patients had evidence of >50% stenosis, of which 131 patients (13.1%) subsequently had an angiogram. Of these, 77 (7.7%) had evidence of significant disease and underwent intervention.
Conclusion:
CTCA is often requested for indications other than chest pain. The use of CTCA resulted in only a small proportion of patients proceeding for invasive coronary angiography, and helps in triaging patients better.
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