"CT coronary angiography is a non invasive, painless, fast,
OPD basis examination of coronary arteries with the help of fast multi slice CT
scanner (16 slice Somatom Sensation Cardiac CT scanner). This fast sub second
scan with help of retrospective ECG gating allows capturing images of heart
between beats and visualizing coronary arteries in single breath hold. CT
Coronary Angiography is much safer without the risks of invasive angiography
& it can localize, visualize & quantify the earliest possible evidence
of coronary artery disease."
incorporation of coronary CT angiography (CCTA) in the early assessment of
patients with chest pain in emergency departments can significantly reduce the
time spent by patients in the hospital.
is also a marked reduction in additional expenses and threat of exposing
patients to potential risks.
includes advanced CT scanning with the application of intravenous contrast material
that produces detailed images the blood vessels supplying heart without cardiac
Hoffmann and colleagues assessed the use of coronary CT angiography against
standard evaluation in acute chest pain. The trial was done in nine U.S.
hospitals and was published in New England Journal of Medicine, 2012.
this multicenter trial volunteers aged between 40 to 74 years with suggestive
symptoms of acute coronary syndromes were randomly enrolled. They did not had
ischemic electrocardiographic changes or an initial positive troponin test to
Hoffmann, MD, MPH, director of the Cardiac MR PET CT program at Massachusetts
General Hospital (MGH) and corresponding author of the NEJM article said, We
found that the use of CCTA in emergency department evaluation of acute chest
pain very effectively identified which patients did or did not have coronary
artery obstruction, allowing clinicians to focus the use of resources on
patients with heart disease."
use of coronary CT angiography (CCTA) in addition to the regular diagnostic
testing for coronary ailments remarkably reduced the treatment cost and
duration of stay in the hospital in contrast to the current standard protocol.
multicenter trial revealed the rate of acute coronary syndromes in 1000
patients as 8 percent in 47 percent. The duration of hospital stay was
noticeably reduced by 7.6 hours and the number of patients discharging from
emergency department also increased.
of the coronary CT angiography (CCTA) patients were discharged within 8.6 hours
and only 10 percent of the control group was released so quickly.
researchers found that the volunteers in coronary CT angiography (CCTA) group
had marked reductions in the time from arrival to emergency department until
discharging either from the emergency or after being admitted to the hospital.
In the coronary CT angiography (CCTA) group the time till the confirmation of
the diagnosis was shorter as compared to control group. However the percentage
of patients being diagnosed with heart diseases was identical in both the
groups (8 percent) and no missed diagnoses occurred in both groups.
Coronary CT angiography (CCTA) volunteers were exposed to
high cumulative doses of radiation but Hoffmann suggested that coronary CT
angiography (CCTA) cal also be performed successfully using low doses and
further future studies should test the usefulness of low dose coronary CT
said, "It's very important to strive for the greatest efficiency in diagnostic
testing, and in this study, additional testing was primarily carried out in
patients found to have coronary artery disease. There also were fewer adverse
clinical events in those receiving CCTA, although the study group was too small
to conclude that CCTA reduced those risks."
further added, "I'd really like to commend the commitment and teamwork of
all the participating sites and departments, which was essential to the
successful completion of this study."
randomized trial highlighted the significance of coronary CT angiography scan
in safely evaluating the diagnosis and facilitating a speedy emergency
department discharge for low-to-intermediate-risk patients.
multicenter trial was funded by the National Heart, Lung, and Blood Institute;
CT Angiography versus Standard Evaluation in Acute Chest Pain; Udo Hoffmann et
al; N Engl J Med 2012; 367:299-308