Published on:June 2016
    Journal of Cardiovascular Disease Research, 2016; 7(2):64-70
    Original Article | doi:10.5530/jcdr.2016.2.2

    Imaging for Chest Pain Assessment: An Algorithmic Approach Using Non-invasive Modalities to Define Medical vs. Interventional Treatment

    Authors:

    Taylor Graber1, Robert Hamburg1,2, Eric vanSonnenberg1,3, Paul Kang1

    1University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA.

    2Central Arizona Heart Specialists, Chandler, Arizona, USA.

    3David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.

    Abstract:

    Background: To analyze the roles of CCTA, MPI, and CC to formulate a sequential clinical algorithm to use in patients with chest pain, risk factors for CAD, and an abnormal EKG. The goals of the study are to streamline and refine workup, to decrease radiation exposure to patients, and to contain costs. Materials and Methods: 39 patients underwent CCTA, MPI, and CC within 30 months of each other. CCTA was defined by mild, moderate, or severe CAD. MPI used SSS, SDS, TID, and formal reading to define mild, moderate, or severe physiologic ischemia. CC and coronary intervention cine films were analyzed to define and treat anatomical CAD medically or by intervention. Results: There was strong correlation between CCTA, CC, and treatment type (p < 0.0001). CCTA was able to stratify all patients with mild or severe ischemia to appropriate treatment groups, and to reduce the need for MPI. With moderate ischemia from CCTA, the additional use of MPI could have reduced the need for 16/18 (89%) patients who underwent CC to undergo further testing. No patients with mild or moderate CAD by CCTA, followed by mild to moderate physiologic ischemia by MPI, needed CC or intervention. 37/39 patients (95%) could have avoided one or more tests using our algorithm. Conclusion: CCTA followed by MPI may be used in symptomatic patients with risk factors for CAD and an abnormal EKG to stratify mild and moderate CAD, and to thereby avoid cardiac catheterization. Our algorithm could lead to savings in healthcare expenditures, save patients from unnecessary invasive procedures, decrease radiation exposure, and reduce total cost.

    Key words: CAD, Stable Angina, Treatment, CCTA, MPI, CC, Algorithm.

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