Recent Advances in Coronary Computed Tomography Angiogram: The Ultimate Tool for Coronary Artery Disease

Alalawi, Luay; Budoff, Matthew J.

doi:10.1007/s11883-022-01029-3

Cited by 5 publications

(3 citation statements)

References 36 publications

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“…Not performing this critical diagnostic tool in ACS patients may mislead in treating ACS patients [33,34]. Angiograms not only assist clinicians in the decision-making related to the care of ACS patients but also help to predict the prognosis of the condition [35,36]. Some evidence shows that a timely angiogram helps reduce morbidity and mortality associated with cardiac conditions, as an angiogram defines a care pathway for patients presenting with cardiac conditions [37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Exploring Clinical Trajectories and the Continuum of Care for Patients With Acute Coronary Syndrome in the United Kingdom: A Thorough Cross-Sectional Analysis

Zaki,

Bashir,

Mahdy

et al. 2023

Cureus

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The United Kingdom (UK) has a sustainable healthcare system. Nonetheless, the burden of acute coronary syndrome (ACS) is still a significant challenge. A scarcity of literature primarily focuses on the continuum of care for ACS patients in the UK. Moreover, limited research studies highlight the clinical trajectories of ACS patients across the UK. Therefore, the current study was designed to explore clinical trajectories and the continuum of care for patients with ACS in the UK. Secondary data was obtained from the Myocardial Ischaemia National Audit Project (MINAP) database. The latest data available in the MINAP database was used. As our objective was to explore clinical trajectories and the continuum of care for patients, we retrieved data regarding the care received by ACS patients admitted to hospitals across the UK. The data of 85574 ACS patients was retrieved. A large number (n=47035) of patients were estimated to be eligible for the angiogram; however, an angiogram was performed for 87.15% (n=40995) of eligible patients. Angioplasty within 72 hours of admission was required for most (n=26313) ACS patients. Nonetheless, angioplasty within 72 hours of admission was performed for 59.7% (n=15703) of the eligible patients. There was a significant difference (P<0.05) between different regions of the UK and the percentage of patients for whom angioplasty was performed within 72 hours of admission. Primary percutaneous coronary intervention (PCI) was performed for 23923 ACS patients, of which the door-to-balloon interval for 17590 (73.5%) patients was ≤60 minutes while the door-to-balloon interval for 3086 (12.9%) patients was ≤90 minutes. Out of the total 85574 ACS patients, 65959 (77.08%) patients were discharged on appropriate medications, while 19615 (22.92%) were transferred to another hospital or died there. A total of 75361 were eligible to be referred to cardiac rehabilitation settings. Nonetheless, 64518 (85.61%) were referred to cardiac rehabilitation. About 85000 patients were reported in the UK (England, Northern Ireland, Wales). Optimal care was provided to most patients in the UK. However, some patients received sub-optimal care, highlighting the disparity in the healthcare system. There is a need to explore further the factors that might be responsible for the sub-optimal care to the patients.

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Section: Discussionmentioning

confidence: 99%

Exploring Clinical Trajectories and the Continuum of Care for Patients With Acute Coronary Syndrome in the United Kingdom: A Thorough Cross-Sectional Analysis

Zaki,

Bashir,

Mahdy

et al. 2023

Cureus

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“…103,108 Use CTA, which is currently the best, least-invasive method to accurately visualize the arterial wall, 137 to identify individuals in this age range who have image-evident subclinical atherosclerotic plaques in their coronary arteries. CTA has additional advantages: low radiation dose, inexpensive, visualizes noncalcified (soft) and calcified (hard) plaques, gives information about additional pertinent plaque characteristics [137][138][139] ; the readings are becoming more automated 137,[140][141][142] hence less expensive and more reliable; the contrast agents are safer and given in lower doses; and the test can be used to follow In South Korea, usually radical thyroidectomy followed by lifelong thyroid hormone replacement; about one-third underwent partial thyroidectomy 126 If backed by clinical-trial data, brief induction-phase therapy of intensive plasma apoB lowering and then maintenance-phase therapy (proposed in reference 78 and updated here)…”

Section: "[W]e Ought To Be In a Position To Figure Out Ways To Preven...mentioning

confidence: 99%

Eradicating Atherosclerotic Events by Targeting Early Subclinical Disease: It Is Time to Retire the Therapeutic Paradigm of Too Much, Too Late

Williams

2024

ATVB

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Recent decades have seen spectacular advances in understanding and managing atherosclerotic cardiovascular disease, but paradoxically, clinical progress has stalled. Residual risk of atherosclerotic cardiovascular disease events is particularly vexing, given recognized lifestyle interventions and powerful modern medications. Why? Atherosclerosis begins early in life, yet clinical trials and mechanistic studies often emphasize terminal, end-stage plaques, meaning on the verge of causing heart attacks and strokes. Thus, current clinical evidence drives us to emphasize aggressive treatments that are delayed until patients already have advanced arterial disease. I call this paradigm too much, too late. This brief review covers exciting efforts that focus on preventing, or finding and treating, arterial disease before its end-stage. Also included are specific proposals to establish a new evidence base that could justify intensive short-term interventions (induction-phase therapy) to treat subclinical plaques that are early enough perhaps to heal. If we can establish that such plaques are actionable, then broad screening to find them in early midlife individuals would become imperative—and achievable. You have a lump in your coronaries! can motivate patients and clinicians. We must stop thinking of a heart attack as a disease. The real disease is atherosclerosis. In my opinion, an atherosclerotic heart attack is a medical failure. It is a manifestation of longstanding arterial disease that we had allowed to progress to its end-stage, despite knowing that atherosclerosis begins early in life and despite the availability of remarkably safe and highly effective therapies. The field needs a transformational advance to shift the paradigm out of end-stage management and into early interventions that hold the possibility of eradicating the clinical burden of atherosclerotic cardiovascular disease, currently the biggest killer in the world. We urgently need a new evidence base to redirect our main focus from terminal, end-stage atherosclerosis to earlier, and likely reversible, human arterial disease.

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“…Artificial intelligence (AI), as well as related techniques such as radiomics, might be ideally suited to solve these challenges [ 12 , 13 , 14 ]. AI has increasingly been used in CT to assess atherosclerotic plaques and can potentially improve the radiologists’ workflow, reduce image post-processing time, and improve the accuracy of test results [ 15 , 16 , 17 ]. In addition, risk stratification and prognosis can be more accurately evaluated as AI enables the processing of large amounts of data [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Advances in Artificial Intelligence-Assisted Coronary Computed Tomographic Angiography for Atherosclerotic Plaque Characterization

Chen,

Zhou,

Xie

et al. 2024

Rev. Cardiovasc. Med.

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Coronary artery disease is a leading cause of death worldwide. Major adverse cardiac events are associated not only with coronary luminal stenosis but also with atherosclerotic plaque components. Coronary computed tomography angiography (CCTA) enables non-invasive evaluation of atherosclerotic plaque along the entire coronary tree. However, precise and efficient assessment of plaque features on CCTA is still a challenge for physicians in daily practice. Artificial intelligence (AI) refers to algorithms that can simulate intelligent human behavior to improve clinical work efficiency. Recently, cardiovascular imaging has seen remarkable advancements with the use of AI. AI-assisted CCTA has the potential to facilitate the clinical workflow, offer objective and repeatable quantitative results, accelerate the interpretation of reports, and guide subsequent treatment. Several AI algorithms have been developed to provide a comprehensive assessment of atherosclerotic plaques. This review serves to highlight the cutting-edge applications of AI-assisted CCTA in atherosclerosis plaque characterization, including detecting obstructive plaques, assessing plaque volumes and vulnerability, monitoring plaque progression, and providing risk assessment. Finally, this paper discusses the current problems and future directions for implementing AI in real-world clinical settings.

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Recent Advances in Coronary Computed Tomography Angiogram: The Ultimate Tool for Coronary Artery Disease

Cited by 5 publications

References 36 publications

Exploring Clinical Trajectories and the Continuum of Care for Patients With Acute Coronary Syndrome in the United Kingdom: A Thorough Cross-Sectional Analysis

Exploring Clinical Trajectories and the Continuum of Care for Patients With Acute Coronary Syndrome in the United Kingdom: A Thorough Cross-Sectional Analysis

Eradicating Atherosclerotic Events by Targeting Early Subclinical Disease: It Is Time to Retire the Therapeutic Paradigm of Too Much, Too Late

Advances in Artificial Intelligence-Assisted Coronary Computed Tomographic Angiography for Atherosclerotic Plaque Characterization

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