Although patients with TA more often had ischemic SPECT, all-cause death was not significantly increased. Nonetheless, TA was associated with more frequent referrals for CATH and revascularization, even with nonischemic SPECT. This may suggest that despite current evidence, the management of stable patients with known or suspected CAD is influenced by symptom type.
IntroductionCoronary computed tomography angiography (CCTA) allows for non-invasive coronary
artery disease (CAD) phenotyping. There are still some uncertainties regarding the
impact this knowledge has on the clinical care of patients.ObjectiveTo determine whether CAD phenotyping by CCTA influences clinical decision making
by the prescription of cardiovascular drugs and their impact on non-LDL
cholesterol (NLDLC) levels.MethodsWe analysed consecutive patients from 2008 to 2011 submitted to CCTA without
previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3
months before CCTA and the second from 3 to 6 months after.ResultsA total of 97 patients were included, of which 69% were men, mean age 64 ±
12 years. CCTA revealed that 18 (18%) patients had no CAD, 38 (39%) had
non-obstructive (< 50%) lesions and 41 (42%) had at least one obstructive
≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ±
52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p =
0.32). We found significative reduction in NLDLC among patients with obstrctive
lesions (-18%, p = 0.001). We also found a positive relationship between clinical
treatment intensification with aspirin and cholesterol reducing drugs and the
severity of CAD.ConclusionOur data suggest that CCTA results were used for cardiovascular clinical treatment
titration, with especial intensification seen in patients with obstructive
≥50% CAD.
Fundamento: A angiotomografia coronariana (AngioTC Cor) permite a fenotipagem de doença arterial coronariana (DAC) de forma não invasiva. Ainda há incertezas sobre o impacto que esse conhecimento pode promover no tratamento clínico do paciente.Objetivo: Avaliar se a fenotipagem da DAC por AngioTC Cor influencia na tomada de decisão quanto a terapêutica preventiva cardiovascular com AAS e estatinas e seu impacto nos níveis séricos de colesterol não-HDL (CNHDL).Método: Foram analisados 124 pacientes sem diagnóstico prévio de DAC que realizaram AngioTC Cor entre os anos de 2008 a 2011 e que tinham realizado duas dosagens seriadas de colesterol sendo a primeira até3 meses antes da AngioTC Cor e a segunda entre 3 a 6 meses após o exame.Resultados: Um total de 97 pacientes foram incluídos, sendo 69% homens, idade média de 64±12 anos. A AngioTC Cor mostrou que 18 (18%) pacientes não apresentavam lesões coronarianas detectáveis, 38 (39%) tinham lesões não obstrutivas (< 50%) e em 42 (43%) foi identificada ao menos uma lesão obstrutiva (≥50%). As medidas de CNHDL basal foram similares entre os grupos (138±52 mg/dl vs. 135±42 mg/dl vs. 131±44 mg/dl, respectivamente, p=0.32). Houve redução significativa do CNHDL apenas no grupo com lesões obstrutivas (-18%, p=0.001).Observou-se ainda aumento do tratamento clínico com AAS e com drogas redutoras de colesterol de forma proporcional ao grau das lesões identificadas pela AngioTC Cor.Conclusão: Esses dados sugerem que o resultado da AngioTC Cor foi utilizado para a titulação terapêutica sendo o tratamento intensificado especialmente em DAC obstrutiva.
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