CT Coronary Angiogram

(CTCA)

What is it? Use of Computed Tomography to image a

beating heart

Non invasive

Good visualisation of the coronary vessels

Provides useful diagnostic information regarding coronary artery disease (CAD)

Conjoint Committee for Recognition of Training in

CTCA Body that governs specialists in Australia and

New Zealand who report CTCA

Radiologist, Cardiologists and Nuclear Medicine Physicians

Complete requisite training criteria

Level A: 150 live and library cases (300 cases every 3 years)

Level B: 300 live and library cases (600 every 3 years)

Why Refer for a CTCA

Examination of coronary artery that is

Low risk

Low radiation

Non invasive

Why Refer for a CTCA

Accurately detect and grade stenosies or narrowing

Demonstrate developmental anomalies of cornary vessels

Check patency of existing grafts

Patients who would benefit…

Suspected CAD

Presents with atypical chest pain

Coronary artery anomaly

Asymptomatic atherosclerosis with known CAD

Post by-pass surgery patients

Indications Based on Framingham criteria (risk score),

previous nuclear and stress echocardiogram or coronary angiography

Framingham criteria is a risk score assessment tool based on a study of

11,611American patients

20-76 years

No self reported CAD, stroke, peripheral arterial dusease or diabetes

Indications Framingham criteria/risk score is based on:

Age

Total cholesterol

HDL cholesterol

Smoking history

Systolic blood pressure

Indications

Results

82% Low: 10% of less CAD risk at 10 years

16% Intermediate: 10-20% CAD risk at 10 years

3% High: More than 20% CAD risk at 10 years

High risk category mainly contained advanced age and male gender

Risk calculator available on internet

Indications Chest pain (Low to intermediate pre test

probability)

CABG and stents (stent length <3mm)

Cardiac conditions

Non coronary valvular surgery

Unexplained heart failure and arrythmias

Coronary anomalies

AF Ablation

Early detection/screening

Rebatable Indications for CTCA

Stable symp;toms consistent with coronary ischaemia, low to intermediate risk or CAD, people who have been considered for coronary angiography

Undergoing non-coronary cardiac surgery

Exclusion of artery anomaly

Comparison of CTCA with Selective Coronary Angiography (>50% luminal

stenosis)n CAD

Prevelance

Sensitivity

Specificity

PPV NPV

ACCURACY

230 25% 95% 83% 64% 99%

CORE64 291 56% 85% 90% 91% 83%

Dutch Study

360 68% 99% 64% 86% 97%

Patient Preparation…

Withould caffeine from midnight prior to examination

4hr fast

BP and HR measurement

If HR >60-65bpm : betablocker

ECG monitoring (gated study)