Authors (including presenting author) :
Cheng CS(1), Ho WF(1), Cheung CW(2), Chan WS(3), Kwong SK(1), Ko WK(1)
Affiliation :
(1) Department of Family Medicine and Primary Health Care, Queen Mary Hospital, Hong Kong West Cluster
(2) Department of Radiology, Queen Mary Hospital, Hong Kong West Cluster
(3) Department of Medicine, Queen Mary Hospital, Hong Kong West Cluster
Introduction :
CT coronary angiography (CCTA) is an important tool to evaluate chest pain suspected to have coronary artery disease (CAD) in origin. Significant stenosis in CCTA is defined as moderate to severe stenosis in any of the coronary artery(ies), and warrants earlier cardiac assessment.
Objectives :
This unprecedented study is to review the current CCTA service’s efficiency in picking up significant stenosis(es) among patients with CAD risk 10-50% and find out the associated clinical risk factors. Hopefully future CCTA prioritization can be made possible for higher risk patients.
Methodology :
The study reviews the results of CCTA ordered by our department from Jan 2015 – Dec 2019. Our old workflow is routine booking for patients with chest pain, CAD risk 10-50% and without ECG ischemic changes. Each medical record is reviewed and relation of stenosis severity to clinical factors analyzed. These include chest pain types, CAD risk categories, smoking, plus diabetes (DM), hypertension, hyperlipidemia and their respective duration. Besides, the review assesses management after CCTA, including antiplatelet/statin use and cardiac appointment time for significant stenosis.
Result & Outcome :
All 99 patients are reviewed. CAD risk 10-50% has a pickup rate of around 23.3 to 37.5%, while analysis of some outlying cases finds a positive rate of 7.7% only for CAD risk < 10% and 100% for risk >50%. DM and smoking are found to have strong association with significant stenosis(es) among CAD risk 10-50% (60% vs 20.6% and 52.6% vs 22.6% respectively). But neither DM duration, HbA1c level nor other risk factors have this association. Around 82% of patients with significant stenosis(es) are newly started on antiplatelet and 50% has statin initiated or increased. 80% of severe stenosis patients are offered early cardiac appointment (in < 3 months).
Collaboration with QMH radiology and cardiology then leads to establishment of new workflow. Patient with chest pain and CAD risk 10-50% in presence of DM or smoking will be prioritized to undergo early CCTA, preferably in 1-2 months. Patients having a risk >50% can also benefit, so earlier result is available for cardiac visit.
