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CTA Evaluation of Stable Chest Pain Patients Associated With Greater Likelihood of Revascularization

Using computed tomography angiography (CTA) to evaluate stable chest pain patients was associated with a higher likelihood of revascularization when compared to other imaging modalities or no testing, according to a new study being presented at ACC’s Cardiovascular Summit 2024, taking place Feb. 1-3 in Washington, DC.

William E. Downey, MD, FACC, et al., assessed 786 patients at the Atrium Health-Sanger Heart & Vascular Institute in Charlotte, NC, between October 2022 and June 2023. These patients (mean age 66 years, 37 women, 81% White) had no prior diagnosis of coronary artery disease (CAD) and underwent elective invasive coronary angiography for the evaluation of suspected angina.

Researchers compared rates of subsequent revascularization between patients whose initial evaluation was either coronary CTA (36% of patients); stress testing, including stress echocardiogram (3%), stress myocardial perfusion imaging (15%), and stress MRI (2%); or clinical judgement (44%).

Patients who underwent initial evaluation via CTA had a subsequent revascularization rate of 62%, as opposed to 34% of patients for the combination of other testing modalities or direct invasive coronary angiography referral.

According to the authors, these findings provide “real world” credence to past randomized trials showing similar benefits to a “CT first” strategy.

“While care must be individualized, for patients with unknown or unestablished [CAD], the transition to a ‘CT first’ strategy should be a high priority for cardiovascular care providers,” said Markus D. Scherer, MD, FACC, the study’s senior author. “The non-invasive approach has a lower risk and cost than a diagnostic heart catheterization and, for the CT approach – but not stress testing – provides information on the absence, presence and extent of coronary atherosclerosis and whether or not there are high risk plaques as well as vessel blockages, which helps streamline patient management and risk reduction.”

ACC’s Cardiovascular Summit brings together all members of the cardiovascular care team, highlighting best practices for creating a more efficient, effective and equitable health care system. Attendees will learn about innovative strategies and emerging trends in cardiovascular care, assess operational efficiencies to enhance the effectiveness of the cardiovascular service line, and adopt customizable approaches that support economic sustainability.

Other abstracts being presented at the Summit include:

  • Optimization of Weekend Ambulatory Services to Reduce Emergency Department Utilization
  • Do Socioeconomic Disparities Arise Through the Care Pathways For Patients With Aortic Stenosis?
  • Heart and Vascular: Role Delineation and Ambulatory Clinic Staffing

Stay up to date throughout the Summit by using the hashtag #ACCCVSummit and following the ACC on social media.

Subscribe to ACC Anywhere to watch the sessions from ACC’s Cardiovascular Summit 2024. In addition to this course, ACC Anywhere features videos from ACC’s in-person and virtual meetings including Care of the Athletic Heart, Advancing the Cardiovascular Care of the Oncology Patient, ACC.23 Together with WCC and ACC.22, New York Cardiovascular Symposium, and Cardio-Obstetrics Essentials.

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging

Keywords: Workforce, Patient Care Team, Delivery of Health Care, Risk Reduction Behavior, Clinical Reasoning, Chest Pain, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease, CV Summit

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