Coronary Computed Tomography Angiography as part of initial strategy, in assessment of patients with chest pain – clinical experience and 1 year prognosis.

Han Bing, Chow and H. S., Ling and E. Z., Chan and B. K., Chung and L. K., Then and I. X., Pang and S. T., Chan and H. K., Khor and C. T., Tan and Y. Y., Oon and K. T., Koh and Y. L., Cham and Asri, Said and A. Y. Y., Fong and T. K., Ong (2022) Coronary Computed Tomography Angiography as part of initial strategy, in assessment of patients with chest pain – clinical experience and 1 year prognosis. International Journal of Cardiology, 369 (Supp.). pp. 23-24. ISSN 0167-5273

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Abstract

Background: Coronary computed tomography angiography (CCTA) has been showed to have high specificity and sensitivity for detecting coronary artery disease (CAD). In Malaysia, national guidelines state that CCTA may be used in low- to intermediate pre-test probability (LI-PTP) of CAD, who have an equivocal functional test result, and who are asymptomatic or mildly symptomatic with good exercise capacity. Recent evidence suggested a ‘CCTA-first’ strategy in the evaluation of a patient with chest pain could provide prognostic benefits. Prognostic benefits of adopting this strategy in Malaysia has not been well studied. Objectives: We aimed to evaluate 12-month clinical outcomes of patients with LI-PTP, using the CCTA as an initial strategy, or as part of the work-up for, chest pain assessment. Methods: Consecutive patients who underwent CCTA examination from January 2020 to January 2021 were enrolled. Clinical information was then extracted. Primary outcome was defined as presence of stenosis of >50% in a major epicardial coronary artery; and secondary outcome defined as a composite of all-cause mortality, non-fatal myocardial infarction (MI) and coronary revascularisation. Results: Among the initial 499 patients, 7 were excluded as they were high in PTP. The mean PTP was 47.1±26.3. Baseline characteristics were available in 300 patients. The mean age was 53.5±11.4 years, 59.3% were male, 18.6% were diabetic, 71.2% had hypertension, and 50.8% had hypercholestrolaemia. 1.9% had an equivocal functional test for ischaemia. Of the 492 LI-PTP patients who underwent CCTA, 136 patients were suspected to have significant CAD, and recommended conventional coronary angiography (CCA). Of these, 91 patients underwent CCA. From this group 38 were found to have significant CAD which warranted revascularisation – 32 by percutaneous coronary intervention (PCI) and 6 referred for coronary artery bypass surgery (CABG). Therefore, utilising this strategy, 7.7% (38/492) of patients met the primary outcome. Of the original cohort of 492 LI-PTP patients, only 230 completed 1 year follow up, and from this, one patient met the secondary outcome. Conclusion Incorporation of CCTA into contemporary chest pain evaluation identified significant number of patients with significant CAD and was also associated with a low cardiac event rate at 1 year follow-up.

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