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HomeLifestyleResearchers find CT scan effective in evaluating people with chest pain

Researchers find CT scan effective in evaluating people with chest pain

Previous studies found that less than 40 percent of patients with stable chest pain who underwent invasive coronary angiography had obstructive coronary artery disease. Recent randomized clinical trials have shown that evaluating these patients first with computed tomography angiography (CTA) is beneficial, and a new study presented at the American College of Cardiology Cardiovascular Summit supports this strategy, finding that CT was associated with a increased likelihood of revascularization when compared to other imaging modalities or no test.
Stable angina is a type of chest discomfort that occurs when the heart muscle requires more oxygen than usual, such as under stress, exercise, or cold weather, but does not receive it, which is commonly caused by blocked coronary arteries. Patients with stable angina are typically treated with pharmaceutical medications and lifestyle changes according to guidelines, but may also require a coronary revascularization procedure to restore adequate blood flow and relieve their symptoms.
“Right now, when a patient presents to their primary care physician or cardiologist with symptoms suspicious of angina, they are commonly referred for additional testing,” said Markus Scherer, MD, director of cardiac CT and structural heart imaging at Atrium Health. -Sanger Heart. & Vascular Institute and lead author of the study.
Between October 2022 and June 2023, researchers at Atrium Health-Sanger Heart & Vascular Institute in Charlotte, North Carolina, evaluated 786 patients who had no prior diagnosis of coronary artery disease and underwent invasive coronary angiography. (ACI) to evaluate suspected angina. . Pre-ICA testing strategies were: non-invasive testing with direct referral to ICA (44%), stress echocardiogram (3%), stress myocardial perfusion imaging (15%), stress MRI (2%) and coronary CT angiography (36%). The study cohort had a mean age of 66 years, was 63% male, 37% female, 81% white, 13% black, 1% Asian, 1% Hispanic, and 1% other.
The investigators compared subsequent revascularization rates between patients whose initial evaluation was coronary CTA versus stress testing or clinical judgment (no testing). The “CT first” strategy was associated with subsequent revascularization in 62 percent of patients compared with 34 percent for the combination of other modalities or direct referral to the ICA.
The 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain suggests noninvasive functional imaging or coronary CTA as the initial test without specifying a preference for one over the other.
According to the researchers, there are a multitude of reasons why health systems do not currently use a CT-first approach, including the availability of high-quality CT scanners; availability of qualified cardiac CT interpreting physicians; and challenges in transitioning to a newer approach after decades of pre-established patterns (i.e., stress testing). Furthermore, a CT-first approach is predominantly recommended for patients with non-established coronary artery disease and does not apply to everyone, as some patient factors may reduce the accuracy and utility of coronary CTA.
“While care should be individualized, for patients with unknown or unestablished coronary artery disease, transitioning to a ‘CT first’ strategy should be a high priority for cardiovascular care providers,” Scherer said. “The non-invasive approach has lower risk and cost than a diagnostic cardiac catheterization and, in the case of the CT approach, but not stress testing, provides information about the absence, presence and extent of coronary atherosclerosis and whether or not they exist. high risk plates. as well as vessel blockages, which helps expedite patient management and risk reduction.”
Because coronary CTA is less expensive than nuclear myocardial perfusion imaging and ICA, there is a direct cost savings to patients and third-party payers with the first CT method, according to Scherer. From a health system perspective, the most financially efficient assessment approach becomes more important during the transition to a value-oriented health care system.
According to the authors, the study demonstrates “real-world” credibility for randomized trials showing similar benefits to a “CT-first” strategy and should promote greater adoption of this strategy for the evaluation of patients with chest pain and no established history of coronary heart disease. disease.
“Cardiac cath labs are a critical capital and human resource care environment. Using them for their full disease-treatment potential, rather than diagnosing them, brings the greatest return on these resources to the healthcare system,” Scherer said. (ME TOO)

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