Computed Tomography Coronary Angiography Versus Stress Myocardial Perfusion Imaging for Risk Stratification in Patients With High Occupational Risk

Slim, Jennifer N.; Castillo-Rojas, Laudino M.; Hann, Matt; Symons, John; Martinho, S; Sim, Jison; Jiménez, Santiago; Haney, Brian R.; Villines, Todd C.; Shry, Eric A.; Slim, Ahmad

doi:10.1097/rti.0b013e3181fbf983

Cited by 3 publications

(4 citation statements)

References 9 publications

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Section: Discussionmentioning

confidence: 99%

“…In our own military system, we have successfully utilized CCTA to expeditiously evaluate chest pain syndromes in our soldiers, sailors, marines, and airmen. Coupled with a reduced invasive coronary angiography referral rate and lower false-positive rate compared to myocardial perfusion imaging, 10 the excellent prognosis associated with a normal CCTA study has allowed for rapid return to duty or worldwide deployment. There was an incrementally increasing association between the severity of CAD by CCTA and the rates of MACE as well as isolated endpoints of non-fatal MI, and late revascularization, consistent with the findings in prior prognostic studies.…”

Section: Prognostic Value Of Ccta For Macementioning

confidence: 99%

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Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center

et al. 2014

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Background:Patient prognosis has been shown to directly correlate with the severity of coronary artery disease diagnosed by coronary computed tomography angiography (CCTA). Although the presence of coronary artery calcium has been associated with increased incidence of ischemic stroke, there are no data on the incidence of ischemic stroke based upon the severity of coronary artery disease by CCTA. Therefore, we sought to investigate the rate of major adverse cardiovascular events, including ischemic stroke, based upon the severity of coronary artery disease by CCTA over a 6-year period in a high-volume single military center.Methods:We performed a retrospective chart review of all CCTA studies to evaluate the incidence of all-cause mortality, non-fatal myocardial infarction, ischemic stroke, and late revascularization (>90 days following CCTA) from January 2005 until July 2012. We reviewed 1518 CCTA reports, dividing patients into groups with obstructive (≥50% stenosis), non-obstructive (<50% stenosis), and no coronary artery disease (no angiographic disease). Subsequent major adverse cardiovascular events data (incidence of all-cause mortality, ischemic stroke, non-fatal myocardial infarction, and late revascularization) were obtained.Results:Over a review period of 6 years with a resultant median follow-up period of 22 months (interquartile range = 13–34 months), the major adverse cardiovascular events rate was significantly higher with obstructive coronary artery disease compared to both non-obstructive coronary artery disease and no coronary artery disease (8.9% vs 0.7%, p < 0.001; 8.9% vs 1.6%, p < 0.001). The incidence of ischemic stroke alone was also significantly higher in those with obstructive coronary artery disease compared to those with no coronary artery disease (3.8% vs 0.4%, p < 0.001).Conclusion:Being free of disease on CCTA was associated with excellent cardiovascular prognosis. Obstructive coronary artery disease was associated with a significantly increased incidence of ischemic stroke. There was also a direct correlation between the severity of coronary artery disease on CCTA and cardiovascular prognosis over the follow-up period of 24 months.

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Section: Discussionmentioning

confidence: 99%

Section: Prognostic Value Of Ccta For Macementioning

confidence: 99%

Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center

et al. 2014

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“…78 Furthermore, coronary CTA had an accepted warranty period of at least 24 months with no cardiovascular events in patients without obstructive CAD, 79 as well as much lower incidence of re-evaluation for recurrent chest pain when compared to accepted modalities for chest pain evaluation. 80 coronary CTA has been evaluated in two major military medical centers, with data supporting its negative predictive value, long term warranty, extremely low radiation dose exposure, and overall significant cost saving to the government with little to no impact on mission operations or performance. 62e66 This is important to the military population in a constant state of deployment to global theater of operations, where not only is the cost of evacuation of symptomatic individuals extremely high, but it is also extremely detrimental to the mission's in currently lean operational force.…”

Section: Evaluation Of Acute But Low Risk Chest Pain In the Emergencymentioning

confidence: 99%

Healthcare Policy Statement on the Utility of Coronary Computed Tomography for Evaluation of Cardiovascular Conditions and Preventive Healthcare: From the Health Policy Working Group of the Society of Cardiovascular Computed Tomography

Slim¹,

Jerome

Blankstein

et al. 2017

Journal of Cardiovascular Computed Tomography

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The rising cost of healthcare is prompting numerous policy and advocacy discussions regarding strategies for constraining growth and creating a more efficient and effective healthcare system. Cardiovascular imaging is central to the care of patients at risk of, and living with, heart disease. Estimates are that utilization of cardiovascular imaging exceeds 20 million studies per year. The Society of Cardiovascular CT (SCCT), alongside Rush University Medical Center, and in collaboration with government agencies, regional payers, and industry healthcare experts met in November 2016 in Chicago, IL to evaluate obstacles and hurdles facing the cardiovascular imaging community and how they can contribute to efficacy while maintaining or even improving outcomes and quality. The summit incorporated inputs from payers, providers, and patients' perspectives, providing a platform for all voices to be heard, allowing for a constructive dialogue with potential solutions moving forward. This article outlines the proceedings from the summit, with a detailed review of past hurdles, current status, and potential solutions as we move forward in an ever-changing healthcare landscape.

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“…The noninvasive imaging technique, coronary computed tomography angiography (CCTA), which does not require fasting or hospitalization, has recently been developed for evaluating coronary atherosclerosis [17,18], and a standardized report, the Coronary Artery Disease Reporting and Data System (CAD-RADS), has been produced [19,20]; CCTA is especially useful for assessing asymptomatic individuals with risk factors [21][22][23]. Some studies have used CCTA to investigate the relationship between coronary artery disease and shift work in a specific group [24] and to compare it with myocardial perfusion imaging in patients with high occupational risk [25].…”

Section: Introductionmentioning

confidence: 99%

Use of Coronary Computed Tomography Angiography to Screen Hospital Employees with Cardiovascular Risk Factors

Chen

et al. 2021

IJERPH

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The objective of this study was to determine how coronary computed tomography angiography (CCTA) can be employed to detect coronary artery disease in hospital employees, enabling early treatment and minimizing damage. All employees of our hospital were assessed using the Framingham Risk Score. Those with a 10-year risk of myocardial infarction or death of >10% were offered CCTA; the Coronary Artery Disease Reporting and Data System (CAD-RADS) score was the outcome. A total of 3923 hospital employees were included, and the number who had received CCTA was 309. Among these 309, 31 (10.0%) had a CAD-RADS score of 3–5, with 10 of the 31 (32.3%) requiring further cardiac catheterization; 161 (52.1%) had a score of 1–2; and 117 (37.9%) had a score of 0. In the multivariate logistic regression, only age of ≥ 55 years (p < 0.05), hypertension (p < 0.05), and hyperlipidemia (p < 0.05) were discovered to be significant risk factors for a CAD-RADS score of 3–5. Thus, regular and adequate control of chronic diseases is critical for patients, and more studies are required to be confirmed if there are more significant risk factors.

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Computed Tomography Coronary Angiography Versus Stress Myocardial Perfusion Imaging for Risk Stratification in Patients With High Occupational Risk

Abstract: Compared with MPI, CCTA significantly reduced ICA referral and false-positive noninvasive imaging rates among symptomatic patients with a low probability of coronary artery disease but high occupational risk.

Cited by 3 publications

References 9 publications

Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center

Assessment of major adverse cardiovascular events and ischemic stroke with coronary computed tomography angiography based upon angiographic diagnosis in a high-volume single center

Healthcare Policy Statement on the Utility of Coronary Computed Tomography for Evaluation of Cardiovascular Conditions and Preventive Healthcare: From the Health Policy Working Group of the Society of Cardiovascular Computed Tomography

Use of Coronary Computed Tomography Angiography to Screen Hospital Employees with Cardiovascular Risk Factors

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