Single Rural Referral Hospital Experience with Computed Tomography Coronary Angiogram for Evaluation of Low-to-Intermediate Risk Coronary Artery Disease

Abstract

Background: Low-to-intermediate risk acute coronary syndrome (ACS) is a common presentation to rural referral hospitals who do not have on site percutaneous coronary angiography capability. They present a complex management problem, given issues with prolonged length of stay waiting for referral and transport to a coronary angiography capable centre. Computed tomography coronary angiogram (CTCA) is used in Australia under Medicare Benefits Schedule item No. 57360 for patients with stable symptoms consistent with coronary ischaemia, at low-to-intermediate risk of coronary artery disease (CAD) and would have been considered for coronary angiography. Methods: We analysed forty-four consecutive patients referred for CTCA from the Maitland Hospital between April 2015 and March 2016, who were admitted following initial assessment that determined them to be of low-to-intermediate risk and requiring inpatient investigation for CAD. Primary endpoint was to identify safe reduction in coronary angiography by mortality and recurrent ACS in 12 months. Results: Thirty-seven patients (84.1%) safely avoided referral for coronary angiography following normal CTCA investigation. Seven patients (15.9%) required subsequent coronary angiography, with four of those patients (9.1%) requiring percutaneous coronary intervention. 12-month mortality was zero and recurrent admission for ACS occurred in 3 (6.8%) patients. Conclusion: At rural referral hospitals without onsite coronary angiography capability, selective use of CTCA for investigation of significant CAD in low-to-intermediate risk patients with chest pain may safely avoid percutaneous coronary angiography.