Low-Risk, Stable Chest Pain Patients and Calcium Score of Zero
Low-Risk, Stable Chest Pain Patients and Calcium Score of Zero
This prospective observational registry study included consecutive patients who were referred to the cardiology outpatient department of Aintree University Hospital, Liverpool, by primary care physicians for assessment of non-acute, stable chest pain syndromes between January and December 2011. They were risk stratified in clinic using the NICE guidelines, as above, and suitability for CACS and CTCA was assessed. The exclusion criteria were known allergy to iodinated contrast media or history of contrast-induced nephropathy, history of multiple myeloma or previous organ transplantation, calculated creatinine clearance of <60 ml/min, atrial fibrillation or uncontrolled tachyarrhythmia, second- or third-degree atrioventricular block, evidence of New York Heart Association (NYHA) functional class III or IV heart failure, known or suspected moderate or severe aortic stenosis, known CAD, known or suspected intolerance to beta blockers, body mass index >40 kg/m, and pregnancy.
All consecutive patients with a low probability of CAD (10–29%), and who did not have any of the exclusion criteria above, underwent a CACS followed by CTCA. This was in line with the recommendation from the British Society of Cardiovascular Imaging. Imaging was performed on a Toshiba Aquilion 160-slice CT scanner and analysed by a consultant cardiologist and consultant radiologist as per Society of Cardiovascular Computed Tomography guidelines. The reports were collated and analysed by calcium scores derived from the Agatston calculation. The different levels of stenoses, as reported on the CTCA, were split into mild, moderate and severe. Mild stenosis was defined as 1–49%, moderate stenosis as 50–69% and severe stenosis as ≥70%. Mild and moderate stenoses were termed non-obstructive, whereas severe stenosis was defined as being obstructive and, hence, significant.
Methods
This prospective observational registry study included consecutive patients who were referred to the cardiology outpatient department of Aintree University Hospital, Liverpool, by primary care physicians for assessment of non-acute, stable chest pain syndromes between January and December 2011. They were risk stratified in clinic using the NICE guidelines, as above, and suitability for CACS and CTCA was assessed. The exclusion criteria were known allergy to iodinated contrast media or history of contrast-induced nephropathy, history of multiple myeloma or previous organ transplantation, calculated creatinine clearance of <60 ml/min, atrial fibrillation or uncontrolled tachyarrhythmia, second- or third-degree atrioventricular block, evidence of New York Heart Association (NYHA) functional class III or IV heart failure, known or suspected moderate or severe aortic stenosis, known CAD, known or suspected intolerance to beta blockers, body mass index >40 kg/m, and pregnancy.
All consecutive patients with a low probability of CAD (10–29%), and who did not have any of the exclusion criteria above, underwent a CACS followed by CTCA. This was in line with the recommendation from the British Society of Cardiovascular Imaging. Imaging was performed on a Toshiba Aquilion 160-slice CT scanner and analysed by a consultant cardiologist and consultant radiologist as per Society of Cardiovascular Computed Tomography guidelines. The reports were collated and analysed by calcium scores derived from the Agatston calculation. The different levels of stenoses, as reported on the CTCA, were split into mild, moderate and severe. Mild stenosis was defined as 1–49%, moderate stenosis as 50–69% and severe stenosis as ≥70%. Mild and moderate stenoses were termed non-obstructive, whereas severe stenosis was defined as being obstructive and, hence, significant.
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