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Computed Tomography Coronary Angiography PowerPoint Presentation

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Description : Check out this medical presentation on Angiography, which is titled "Computed Tomography Coronary Angiography", to know about Computed Tomography Coronary Angiography in Patients with Suspected Angina due to Coronary Heart Disease.

Tags : Angiography, Computed Tomography, Coronary Angiography, Angina, Heart Disease

Published on : May 25, 2021 | Views : 3222 | Downloads : 3

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Slide 1-

Computed Tomography Coronary Angiography in Patients with Suspected Angina due to Coronary Heart Disease David Newby On behalf of the The Scottish COmputed Tomography of the HEART (SCOT-HEART) Trial Investigators
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Declarations Funder Chief Scientist Office, Scotland, UK (CZH/4/588) Supplementary awards from Edinburgh and Lothian Health Foundation and the Heart Diseases Research Fund Sponsors University of Edinburgh and NHS Lothian Conflicts of Interest DEN, EvB, GMcK and GR have undertaken consultancy for one or more of the following companies: Toshiba, Bracco, Bayer-Schering, GE Healthcare and Guerbet
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Angina due to Coronary Heart Disease Non-cardiac Chest Pain Clinic Assessment of Patients with Suspected Angina due to CHD Fatal and Non-fatal Myocardial Infarction Sekhri et al. Heart 2007;93:458–463
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Scottish COmputed Tomography of the HEART (SCOT-HEART) Trial First trial to determine the effect of CTCA on the clinical assessment of patients presenting with suspected angina due to coronary heart disease Diagnosis (Primary Endpoint) Investigations Treatments Outcomes
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Scottish COmputed Tomography of the HEART (SCOT-HEART) Trial Diagnosis: Primary Endpoint Diagnosis of Coronary Heart Disease Diagnosis of Angina due to Coronary Heart Disease Yes Probable Unlikely No Certainty: Yes/No versus Probable/Unlikely Frequency: Yes/Probable versus Unlikely/No
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Scottish COmputed Tomography of the HEART (SCOT-HEART) Trial Entry Criteria Inclusion Criteria Age 18-75 years Suspected angina due to coronary heart disease Exclusion Criteria Inability to undergo CT scanning Renal failure (estimated GFR <30 mL/min) Allergy to contrast media Pregnancy Acute coronary syndrome within 3 months Previous recruitment to the trial No restriction according to: Arrhythmia Obesity (65 kg/m2) Calcium score (9015 AU)
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The SCOT-HEART Trial Study Protocol Primary Care Physician Referral Clinic Consultation History, Examination, 12-lead ECG Exercise ECG if appropriate Diagnosis, Investigations and Treatment Plan Documented Approached for Study Inclusion Angina Questionnaire Randomised 1:1 to CTCA + Standard Care or Standard Care alone Result to Attending Clinician Cardiovascular Risk Assessment: ASSIGN Score 6-Week Attending Clinician Review Diagnosis, Investigations and Treatment Plan 6-Week Patient Review Angina Questionnaire Clinical Outcome NHS Health Records Computed Tomography Coronary Angiogram
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Scottish COmputed Tomography of the HEART (SCOT-HEART) Trial Trial Centers Perth Royal Infirmary, Perth Ninewells, Dundee Victoria Hospital, Kirkcaldy Western General Hospital, Edinburgh Royal Infirmary, Edinburgh Borders General Hospital, Melrose St John’s Hospital, Livingston Forth Valley Hospital, Larbert Western Infirmary, Glasgow Glasgow Royal Infirmary, Glasgow Royal Alexandra Hospital, Paisley University Hospital, Ayr 12 Centers Across Scotland Complete Health Record Data Capture One National Healthcare Provider
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47% of Eligible Patients Recruited Into the Trial Only 11% of All Patients Excluded From the Trial Scottish COmputed Tomography of the HEART (SCOT-HEART) Trial Trial Population Patients Referred for Evaluation of Suspected Angina due to Coronary Heart Disease n=9,849 Eligible Patients for SCOT-HEART trial n=8,767 Ineligible Patients n=1,082 Eligible Recruited Patients for SCOT-HEART trial n=4,146 Eligible Non-recruited Patients n=4,621 Missing 137 Patient preference 2613 Clinician choice 547 Not Approached 992 Other 332 Randomization 1:1 n=4,146
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100% Data for the Primary End-point Scottish COmputed Tomography of the HEART (SCOT-HEART) Trial Trial Population Intention-to-Treat Analysis Standard of Care n=2,073 Standard of Care + CT Coronary Angiogram n=2,073 Computed Tomography Coronary Angiogram n=3 CT Coronary Angiogram n=1,778 Non-completion 295 Ill-health/death 6 Patient default 245 Technical 10 Other 34 Data for Primary Endpoint n=2,073 Data for Primary Endpoint n=2,073 Randomization 1:1 n=4,146
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Normal Non-Obstructive Obstructive Coronary Artery Disease Frequency CT Coronary Angiography Prevalence of Coronary Heart Disease Clinicians Reporting CTCA Diagnosis of Angina due to CHD Certainty RR 3.76 [95% CI, 3.61-3.89] Frequency RR 0.78 [95% CI, 0.70-0.86]
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CT Coronary Angiography Safety Adverse Reactions & Radiation Dose Median Radiation Dose: 4.1 mSv (Interquartile Range 3.0-5.6) Dose-length Product: 291 mGy.cm (Interquartile Range 216-397) 37% Radiation Dose Attributable to Coronary Artery Calcium Score
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CT Coronary Angiography: Diagnosis Baseline Compared to 6 Weeks 0.0 1.0 2.0 3.0 4.0 Relative Risk [95% Confidence Intervals] Overall Changes in Diagnosis: 25% versus 1%, P<0.001 1.79 [1.62-1.96] 0.93 [0.85-1.02] Attending Clinician: Diagnosis of Angina due to CHD (Primary End-point) Certainty Frequency 2.56 [2.33-2.79] 1.09 [1.02-1.17] Attending Clinician: Diagnosis of Coronary Heart Disease Certainty Frequency
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Frequency Stress Testing Invasive Coronary Angiography All Tests Cancellations CTCA and Investigations Baseline Compared to 6 Weeks Overall Changes in Investigations: 15% versus 1%, P<0.001 CTCA Report in those with cancelled Invasive Coronary Angiogram: Normal 52% Non-obstructive 31% Obstructive 17%
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Frequency Stress Testing Invasive Coronary Angiography All Tests New Investigations CTCA and Investigations Baseline Compared to 6 Weeks Overall Changes in Investigations: 15% versus 1%, P<0.001 CTCA Report in those with new Invasive Coronary Angiogram: Normal 0% Non-obstructive 12% Obstructive 88%
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Frequency Frequency Preventative Therapy Anti- Anginal Therapy All Therapies Cancellations New Treatments Preventative Therapy Anti- Anginal Therapy All Therapies CTCA and Medical Therapy Baseline Compared to 6 Weeks Overall Changes in Treatments: 23% versus 5%, P<0.001
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CTCA and Symptoms Baseline Compared to 6 Weeks Seattle Angina Questionnaire Baseline 6 Weeks Baseline 6 Weeks Angina Stability Angina Frequency No Overall Change in Symptoms at 6 Weeks Overall Treatment Satisfaction High (92/100) in Both Groups
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CTCA and Clinical Outcome 1.7 Years of Follow-up CHD Death and Non-Fatal MI 5 4 3 2 1 0 0 1 3 2073 1571 323 2073 1550 316 CTCA Standard Care Follow Up (years) Proportion of patients with an event (%) 853 837 2 5 4 3 2 1 0 0 1 3 CTCA Standard Care Follow Up (years) Proportion of patients with an event (%) 2073 1569 321 2073 1547 315 851 835 2 HR 0.62 [0.38-1.01], P=0.053 HR 0.64 [0.41-1.01], P=0.056 CHD Death, Non-Fatal MI and Non-fatal Stroke CTCA Standard Care CTCA Standard Care
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15 10 5 0 0 1 3 CTCA Standard Care Follow Up (years) Proportion of patients with an event (%) 2073 1386 270 2073 1413 276 733 755 2 CTCA and Clinical Outcome Coronary Angiography & Revascularisation HR 1.20 [0.99-1.45], P=0.061 CTCA Standard Care Coronary Angiography Coronary Revascularisation HR 1.06 [0.92-1.21], P=0.451 25 15 5 0 0 1 3 CTCA Standard Care Follow Up (years) Proportion of patients with an event (%) 2073 1249 227 2073 1263 226 634 660 2 10 20 CTCA Standard Care
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Conclusions In patients presenting with suspected angina due to coronary heart disease, the addition of computed tomography coronary angiography Clarifies the diagnosis: 1 in 4 Increases the diagnosis of CHD but appears to reduce the diagnosis of angina due to CHD Alters subsequent investigations: 1 in 6 Changes treatments: 1 in 4 Does not affect short-term anginal symptoms May increase coronary revascularisation and reduce fatal and non-fatal myocardial infarction
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Royal Infirmary of Edinburgh, Edinburgh: Ms Barbara Allen, Prof Edwin van Beek, Dr Miles Behan, Miss Danielle Bertram, Mr David Brian, Ms Amy Cowan, Dr Nicholas Cruden, Dr Martin Denvir, Dr Marc Dweck, Ms Laura Flint, Dr Andrew Flapan, Miss Samantha Fyfe, Dr Neil Grubb, Mrs Collette Keanie, Dr Chris Lang, Dr Tom MacGillivray, Dr David MacLachlan, Miss Margaret MacLeod, Dr Saeed Mirsadraee, Mrs Avril Morrison, Dr Nicholas Mills, Dr David Northridge, Mrs Alyson Phillips, Miss Laura Queripel, Dr John Reid, Dr Neal Uren, Dr Nicholas Weir St John’s Hospital, Livingston; Dr Ashok Jacob, Mrs Fiona Bett, Mrs Frances Divers, Ms Katie Fairley, Ms Edith Keegan, Ms Tricia White, Ms Julia Fowler University Hospital, Ayr: Dr John Gemmill, Dr James McGowan, Mrs Margo Henry Victoria Hospital, Kirkcaldy: Dr Mark Francis, Mr Dennis Sandeman Ms Lorraine Dinnel Western General Hospital, Edinburgh: Prof David Newby Dr Peter Bloomfield, Dr Martin Denvir, Dr Peter Henriksen, Dr Donald MacLeod, Mrs Avril Morrison Western Infirmary, Glasgow & Institute of Cardiovascular & Medical Sciences, University of Glasgow: Prof Colin Berry, Dr Kenneth Mangion, Dr Ify Mordi, Dr Giles Roditi, Dr Nikolaos Tzemos, Dr Eugene Connolly, Mrs Heather Boylan, Mrs Ammani Brown, Ms Lesley Farrell, Mrs Alison Frood, Ms Caroline Glover, Mrs Janet Johnstone, Mrs Tracey Steedman, Mrs Kirsten Lanaghan, Mrs Deborah McGlynn, Ms Lorraine McGregor, Ms Evonne McLennan, Ms Laura Murdoch, Miss Victoria Paterson, Ms Fiona Teyhan, Ms Marion Teenan, Ms Rosie Woodward Borders General Hospital, Melrose: Dr Paul Neary Mrs Gillian Donaldson, Mr Terry Fairbairn, Mrs Marlene Fotheringham, Mrs Fiona Hall. Forth Valley Royal Hospital, Larbert: Dr Allister Hargreaves, Dr James Spratt, Dr Stephen Glen, Ms Sarah Perkins, Ms Fiona Taylor Mrs Louisa Cram, Ms Catherine Beveridge, Ms Avril Cairns, Ms Frances Dougherty Glasgow Royal Infirmary: Dr Hany Eteiba, Dr Alan Rae, Ms Kate Robb, Ms Wenda Crawford, Ms Patricia Clarkin, Ms Elizabeth Lennon Ninewells Hospital, Dundee: Prof. Graeme Houston, Prof Stuart Pringle, Dr Prasad Guntur Ramkumar, Dr Thiru Sudarshan, Dr Yvonne Fogarty, Ms Dawn Barrie, Ms Kim Bissett, Dr Adelle Dawson, Mr Scott Dundas, Mrs Deborah Letham, Ms Linda O’Neill, Mrs Valerie Ritchie. Perth Royal Infirmary, Perth: Dr Hamish Dougall Royal Alexandra Hospital, Paisley: Dr Faheem Ahmed, Dr Alistair Cormack, Dr Iain Findlay, Dr Stuart Hood, Dr Clare Murphy, Dr Eileen Peat, Ms Lynne McCabe, Ms Margaret McCubbin.