Computed tomography coronary angiography as initial work-up for unstable angina pectoris

Abstract

Computed Tomography Coronary Angiography (CTCA) is a rapid, non-invasive diagnostic tool for coronary artery disease (CAD). Rapid Access Chest Pain Clinics (RACPC) were introduced in UK in 2000, in order to assess rapidly patients with chest pain. To evaluate the use of CTCA as initial work-up for unstable angina pectoris in a primary care-based RACPC. Eighty-eight (n=88) patients were examined by a consultant cardiologist and referred for CTCA if indicated. CTCA was performed with a 640 slices, 320-row CT scanner. Thirty-five (n=35) patients were discharged without further investigations; 50 (mean age 59.8 years; 24 male) were referred for CTCA and 3 were referred directly for an invasive angiography (IA). Following CTCA, 17 patients were discharged. Seventeen (n=17) patients with no history of CAD, but with positive CTCA findings and eleven (n=11) patients with known CAD but without new lesions on CTCA were discharged after optimisation of medical treatment. Five (n=5) of the 50 patients eventually underwent IA; 2 were referred for CABG; 3 continued with medical treatment. No major adverse cardiac events were recorded in a 6-months' follow up period. The cost for each patient who underwent CTCA was £1,087; 94% of patients rated their experience as good or excellent. The time interval from RACPC visit-to-definitive diagnosis was <3 weeks in 50% of patients, <6 weeks in 90%. Use of CTCA as initial investigation in Primary Care, is both clinically and cost-effective. CTCA should be considered in the initial diagnostic work-up of unstable angina pectoris patients, with or without prior history of CAD.