Invasive Coronary Procedures Research Articles

Acute heart failure precipitated by acute coronary syndrome - patient characteristics, management and survival

Purpose: Acute coronary syndrome (ACS) may precipitate up to one third of acute heart failure (AHF) cases. As scientific data is scarce, we assessed characteristics, management and survival of patients with ACS as a precipitating factor of AHF (AHF-ACS). Methods: Data of 620 patients hospitalized due to AHF were prospectively collected in a multicenter study. All-cause mortality was assessed during 12 months follow-up. The data were compared between patients with and without ACS. Comparisons between groups were performed by χ2 test, t-test or Mann-Whitney U as appropriate. Survival analyses were performed using Kaplan-Meier method and multivariable logistic regression. Results: AHF-ACS patients (32%) had significantly more often coronary artery disease, diabetes and hypercholesterolemia as underlying diseases. Most of the AHF-ACS patients presented with de novo AHF (61% vs 43% in non-ACS, p<0.001). There were no significant differences between the two groups in blood pressure, heart rate or biochemistry (eGFR, sodium, hemoglobin, CRP) on admission. Intravenous nitrates, furosemide, opioids, inotropes and vasopressors as well as non-invasive ventilation and invasive coronary procedures (angiography, PCI, CABG) were used significantly more often in AHF-ACS patients (p<0.001 for all). Although survival at 12 months was similar in the two groups, early mortality was significantly higher in patients with AHF-ACS (Figure). In fact, ACS was a significant predictor of 30-day prognosis in multivariable analysis (adjusted OR 1.9, 95% CI 1.06-3.52, p=0.033). ![Figure][1] Figure 1 Conclusion: AHF-ACS patients differ from those without ACS in terms of underlying diseases and treatment, but not in clinical parameters measured on admission. ACS in AHF was independently related to increased short-term mortality. [1]: pending:yes

Effect of short-term different statins loading dose on renal function and CI-AKI incidence in patients undergoing invasive coronary procedures

Contrast-induced acute kidney injury (CI-AKI) is strongly associated with both increased in-hospital and late morbidity and mortality after invasive cardiac procedure [ [1] Nash K. Hafeez A. Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002; 39: 930-936 Abstract Full Text Full Text PDF PubMed Scopus (1520) Google Scholar ]. Atorvastatin and probucol have been studied for their beneficial effect in preventing CI-AKI; however, little is known about the effect of their combination.

Abstract 1: The Association Between Patient Selection for Diagnostic Coronary Angiography and Hospital-Level PCI Appropriateness: Insights from the NCDR

Background. It is unknown if patient selection for diagnostic coronary angiography is associated with PCI quality as assessed by the Appropriate Use Criteria (AUC). We sought to determine if hospitals that frequently perform coronary angiography in asymptomatic patients, a clinical scenario where the benefit of angiography is less clear, are more likely to perform inappropriate PCI. Methods. We restricted our analyses to patients without known heart disease undergoing elective (non-acute) angiography or PCI at NCDR hospitals reporting at least 50 PCI procedures annually. As not all NCDR participating hospitals report diagnostic angiograms, we excluded hospitals reporting fewer diagnostic coronary angiograms than PCI. We identified 521,125 patients who underwent elective coronary angiography and 155,220 patients who underwent elective PCI at 553 hospitals reporting to the NCDR CathPCI Registry between July 2009 and June 2012. The association between hospital quartiles of the proportion of asymptomatic patients at angiography and the proportion of inappropriate PCI, per the 2012 AUC, was evaluated by Mantel-Haenszel trend test. Results. Overall, 132,613 patients (25.5%) who underwent coronary angiography were asymptomatic. The hospital proportion of asymptomatic patients at angiography ranged from 0.2% to 87.7%. Categorized as hospital quartiles, the median proportion of asymptomatic patients was 7.9% in hospitals of the lowest-quartile, 15.6% in the second lowest-quartile, 23.7% in the second highest-quartile and 35.5% in the highest-quartile. By hospital quartiles, the proportion of asymptomatic patients at angiography was significantly associated with the proportion of inappropriate PCI (median hospital proportion of inappropriate PCI; 17.7% vs. 22.6% vs. 26.5% vs. 28.9% from lowest to highest quartile, p&lt;0.001 for trend; Figure 1). Conclusions. In a national sample of hospitals performing invasive coronary procedures, the proportion of coronary angiograms performed in asymptomatic patients was associated with the proportion of inappropriate PCI. Further study to clarify factors related to practice variability in processes of patient selection prior to the cardiac catheterization laboratory may optimize the use of both diagnostic angiography and PCI.

Large differences between patients with acute myocardial infarction included in two Swedish health registers

Acute myocardial infarction (MI) is a leading cause for morbidity and mortality in Sweden. We aimed to compare patients with an acute MI included in the Register of information and knowledge about Swedish heart intensive care admissions (RIKS-HIA, now included in the register Swedeheart) and in the Swedish statistics of acute myocardial infarctions (S-AMI). Population based register study including RIKS-HIA, S-AMI, the National patient register and the Cause of death register. Odds ratios were determined by logistic regression analysis. From 2001 to 2007, 114,311 cases in RIKS-HIA and 198,693 cases in S-AMI were included with a discharge diagnosis of an acute MI. Linkage was possible for 110,958 cases. These cases were younger, more often males, had fewer concomitant diseases and were more often treated with invasive coronary artery procedures than patients included in S-AMI only. There were substantial regional differences in proportions of patients reported to RIKS-HIA. Approximately half of all patients with an acute MI were included in RIKS-HIA. They represented a relatively more healthy population than patients included in S-AMI only. S-AMI covered almost all patients with an acute MI but had limited information about the patients. Used in combination, these two registers can give better prerequisites for improved quality of care of all patients with acute coronary syndromes.

Design and rationale of the AngioSeal versus the Radial approach In acute coronary SyndromE (ARISE) trial: a randomized comparison of a vascular closure device versus the radial approach to prevent vascular access site complications in non-ST-segment elevation acute coronary syndrome patients

BackgroundArterial access is a major site of bleeding complications after invasive coronary procedures. Among strategies to decrease vascular complications, the radial approach is an established one. Vascular closure devices provide more comfort to patients and decrease hemostasis and need for bed rest. However, the inconsistency of data proving their safety limits their routine adoption as a strategy to prevent vascular complications, requiring evidence through adequately designed randomized trials. The aim of this study is to compare the radial versus femoral approach using a vascular closure device for the incidence of arterial puncture site vascular complications among non-ST-segment elevation acute coronary syndrome patients submitted to an early invasive strategy.MethodsARISE is a national, multicenter, non-inferiority randomized clinical trial. Two hundred patients with non-ST-segment elevation acute coronary syndrome will be randomized to either radial or femoral access using a vascular closure device. The primary outcome is the occurrence of vascular complications at an arterial puncture site 30 days after the procedure, including major bleeding, retroperitoneal hematoma, compartment syndrome, hematoma ≥ 5 cm, pseudoaneurysm, arterio-venous fistula, infection, limb ischemia, arterial occlusion, adjacent nerve injury or the need for vascular surgical repair.ResultsEnrollment was initiated in September 2012, and until October 2013 91 patients were included. The inclusion phase is expected to last until the second half of 2014.ConclusionsThe ARISE trial will help define the role of a vascular closure device as a bleeding avoidance strategy in patients with NSTEACS.Trial registrationClinicalTrials.gov identifier: NCT01653587

The Clinical Utility of Bivalirudin in Patients with Coronary Artery Disease

Bivalirudin, a direct thrombin inhibitor, is an anticoagulant commonly used in invasive cardiology procedures. It has evolved from relative obscurity, as an anticoagulation option only utilized in rare instances of allergy or resistance to heparin products, to the now preferred antithrombotic anticoagulant in the cardiac catheterization laboratory. On the way to displacing unfractionated heparin as the preferred anticoagulant for percutaneous coronary intervention, multiple studies comparing bivalirudin with heparin have consistently shown equivalent ischemic efficacy endpoints (i.e. cardiovascular death, myocardial infarction, etc.), with significant reductions in bleeding. Bleeding has been directly linked to worse hospital outcomes in cardiac patient's undergoing invasive coronary artery revascularization procedures. More recent bivalirudin studies now demonstrate reductions in mortality, which has led to a paradigm shift to bivalirudin as the anticoagulant choice both in elective and emergent coronary procedures. We present the major studies that have brought bivalirudin to the forefront of coronary artery disease, specifically coronary interventional procedures.

Direct medical cost of newly diagnosed stable coronary artery disease in Hong Kong

BackgroundStable coronary artery disease (CAD) affects approximately 7% of the population of Hong Kong and is associated with substantial healthcare costs.ObjectiveWe aimed to evaluate the first-year direct medical cost for...

Radiation dose surveillance using a novel automated, remote-site dose monitoring tool in cardiac catheterization laboratory: A feasibility study

With the ever increasing complexity of invasive coronary procedures i.e. percutaneous coronary intervention (PCI) and electrophysiology procedures (EP), radiation exposure can be high and deleterious to both patient and medical staff [1–4]. While it is important to achieve good procedural outcomes, it is equally imperative to ensure both patient and medical staff are exposed to the minimum necessary dose of radiation [5,6] i.e. “as low as reasonably achievable (ALARA)”. Alarming reports [7,8] of stochastic and deterministic radiation injuries associated with excessive radiation exposure have also been on a steady uptrend over the years.

Surgical pitfalls of minimally invasive direct coronary artery bypass procedure from the viewpoint of a surgeon in the learning curve.

IntroductionMinimally invasive direct coronary artery bypass grafting (MIDCAB) offers arterial revascularization of the left anterior descending (LAD) coronary artery especially in lesions unsuitable for percutaneous coronary interventions. By avoidance of sternotomy and cardiopulmonary bypass its invasiveness is less than that of conventional bypass surgery.AimWe in this study discuss our surgical experience in the MIDCAB procedure.Material and methodsThirteen patients were operated on with the MIDCAB procedure. The inclusion criteria for MIDCAB were pure LAD disease totally occluded or severely stenotic. Patient demographics and preoperative and postoperative data were analyzed.ResultsMean age of the patients was 60.0 ±8.6 years. Patients’ preoperative and postoperative levels of cardiac CK-MB (creatine kinase MB) were not significantly different (p = 0.993). However, cardiac troponin I (p < 0.001), hemoglobin (p < 0.001) and hematocrit (p < 0.001) were significantly different. No perioperative myocardial infarctions or cerebrovascular accidents were seen. The patients were discharged at a mean day of 4.77 with oral antiaggregant therapy. No mortality was seen in the study population.ConclusionsMinimally invasive direct coronary artery bypass is associated with few perioperative complications. Minimally invasive direct coronary artery bypass in our experience is a very good option for single vessel LAD disease.

Transulnar approach as an alternative access site for coronary invasive procedures after transradial approach failure

Unsuccessful radial artery puncture, inability to advance the guide catheter to the ascending aorta, and inadequate guide catheter support represent mechanisms of transradial approach failure. With the rationale of sharing the same efficacy and safety promoted by radial access, the transulnar approach represents an alternative access site for percutaneous coronary procedures. Between May 2007 and May 2012, 11,059 coronary invasive procedures were performed in a single institution: 10,108 by transradial approach (91.4%), 541 by transfemoral approach (4.9%), and 410 by transulnar approach (3.7%). Patients who underwent coronary procedures through transulnar access were included in a prospective registry of effectiveness and safety. Diagnostic procedures accounted for 71.8% of cases, and the right ulnar access was the most common route (88.9%). Procedure success was high (98.5%), with a crossover rate of 1.5% (6 cases), of which 5 were achieved through the contralateral radial access and 1 through femoral approach. Complications related to access site were low (3.9%), consisting mostly of minor bleeding due to subcutaneous hematomas. There were no cases of major bleeding, nerve injury, pseudoaneurysm, arteriovenous fistula, or necessity of vascular surgical repair. The transulnar approach represents an alternative to the transradial approach in selected cases when performed by radial-trained operators, sharing a high success rate and extremely low incidence of access-site complications.

Effectiveness of video information on coronary angiography patients’ outcomes

Coronary angiography is a widely used invasive procedure for diagnosis of coronary artery diseases. The patients benefit from information about an invasive diagnostic procedure. The aim of this study was to evaluate the effects of two educational methods (video information vs. verbal information) on the level of satisfaction, comfort, tolerability and on the heart rate and blood pressure of patients undergoing coronary angiography. A randomized controlled trial design was employed in this study. 128 patients candidate for coronary angiography were randomly assigned to experimental (n = 64) and control (n = 64) groups. The data were collected from January to April 2009. The experimental group watched an informative video about the procedure of coronary angiography as well as pre- and post-angiography care, while the control group received only routine verbal education by nurses. Heart rate and blood pressure were obtained at baseline and after educational intervention. The levels of comfort, satisfaction, and tolerability were measured after the procedure. Statistical analysis was done using SPSS soft ware (Version, 11.5). The experimental group showed a statistically significant decrease in the heart rate and blood pressure after the educational intervention compared to the control group (P < .001). The patients in the experimental group had significantly higher levels of comfort, satisfaction, and tolerability than the control group (P < .001). Patients' education using an informative video before coronary angiography can effectively maximize the patients' outcome. The results of this study confirm the usefulness of video information prior to an invasive coronary angiography procedure.

Fondaparinux em intervenção coronária percutânea no tratamento da síndrome coronária aguda

Fondaparinux in Percutaneous Coronary Intervention for the Treatment of Acute Coronary Syndrome Background: Fondaparinux is considered an agent with a well­established safety and efficacy profile in the treatment of non­ST segment elevation acute coronary syndromes, but when used alone, is associated to a higher incidence of thrombotic com plications during invasive coronary procedures, requiring the supplementation of an anti­IIa agent. This study aimed to evaluate the efficacy and safety of percutaneous coronary in tervention (PCI) in patients with non­ST segment elevation acute coronary syndromes previously treated with fondapari­ nux. Methods: Prospective, controlled registry enrolling 127 consecutive patients submitted to an early invasive stratification during treatment with fondaparinux, with supplementation of intravenous unfractionated heparin at a dose of 85 U/kg at the time of PCI. Results: The rate of the composite primary end point including death, acute myocardial infarction, stroke, stent thrombosis or emergency myocardial revascularization was 3.2%. The cumulative incidence of major bleeding and vascular complications was 3.2%. There were no cases of gui de­ catheter thrombosis or abrupt vessel closure. Conclusions: PCI in patients with acute coronary syndromes receiving fondaparinux is associated with a low rate of major adverse cardiovascular ischemic events and severe hemorrhagic complications. Sup­ ple mentation of unfractionated heparin during the invasive procedures eliminates the risk of catheter­related thrombosis. DESCRIPTORS: Acute coronary syndrome. Angioplasty. Stents. Anticoagulants. Fondaparinux.

Current operator volumes of invasive coronary procedures in medicare patients: Implications for future manpower needs in the catheterization laboratory

We seek to assess the per-operator volume of diagnostic catheterizations and percutaneous coronary interventions (PCI) among US cardiologists, and its implication for future manpower needs in the catheterization laboratory. The number of annual Medicare PCIs peaked in 2004 and has trended downward since, however the total number of catheterization laboratories nationwide has increased. It is unknown whether these trends have resulted in a dilution of per-operator volumes, and whether the current supply of interventional cardiologists is appropriate to meet future needs. We analyzed the Centers for Medicare and Medicaid Services 2008 Medicare 5% sample file, and extracted the total number of Medicare fee-for-service (Medicare FFS) diagnostic catheterizations and PCIs performed in 2008. We then determined per-physician procedure volumes using National Provider Identifier numbers. There were 1,198,610 Medicare FFS diagnostic catheterizations performed by 11,029 diagnostic cardiologists, and there were 378,372 Medicare FFS PCIs performed by 6,443 interventional cardiologists in 2008. The data reveal a marked difference in the 2008 distribution of diagnostic catheterizations and PCIs among operators. Just over 10% of diagnostic catheterizations were performed by operators performing 40 or fewer Medicare FFS diagnostic catheterizations, contrasted with almost 30% of PCIs performed by operators with 40 of fewer Medicare FFS PCIs. A significant majority of interventional cardiologists (61%) performed 40 or fewer Medicare FFS PCIs in 2008. There is a high percentage of low-volume operators performing PCI, raising questions regarding annual volume recommendations for procedural skill maintenance, and the future manpower requirements in the catheterization laboratory.

Fondaparinux in Percutaneous Coronary Intervention for the Treatment of Acute Coronary Syndrome

Fondaparinux is an agent that has a well-established safety and efficacy profile in the treatment of non-ST segment elevation acute coronary syndromes. When used alone, however, it is associated with a higher incidence of thrombotic complications during invasive coronary procedures, requiring the supplementation of an anti-IIa agent. This study aimed to evaluate the efficacy and safety of percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary syndromes that were previously treated with fondaparinux. This was a prospective, controlled registry, enrolling 127 consecutive patients submitted to an early invasive stratification during treatment with fondaparinux with the supplementation of intravenous unfractionated heparin at a dose of 85 U/kg at the time of PCI. The composite primary endpoint rate, including death, acute myocardial infarction, stroke, stent thrombosis, or emergency myocardial revascularisation was 3.2%. The cumulative incidence of major bleeding and vascular complications was 3.2%. There were no cases of guide catheter thrombosis or abrupt vessel closure. PCI in patients with acute coronary syndromes receiving fondaparinux was associated with a low rate of major adverse cardiovascular ischaemic events and severe haemorrhagic complications. Supplementation with unfractionated heparin during the invasive procedures eliminated the risk of catheter-related thrombosis. Fondaparinux em Intervenção Coronária Percutânea no Tratamento da Síndrome Coronária Aguda Considerado um fármaco com adequado perfil de eficácia e segurança no tratamento da síndrome coronária aguda sem supradesnivelamento do segmento ST, o fonda parinux, utilizado de forma isolada, associase a maior ocorrência de complicações trombóticas durante a realização de procedimentos coronários invasivos, requerendo a adição de agente com atividade anti-IIa. Este estudo teve como objetivo avaliar a eficácia e a segurança da intervenção coronária percutânea (ICP) em pacientes admitidos com diagnóstico de síndrome coronária aguda sem supradesnivelamento do segmento ST, previamente tratados com fondaparinux. Registro prospectivo, controlado, envolvendo 127 pacientes consecutivos submetidos a estratificação invasiva precoce na vigência de fondaparinux, com suplementação de heparina não fracionada intravenosa na dose de 85 U/kg no momento da ICP. A taxa do desfecho primário, composto por morte, infarto agudo do miocárdio, acidente vascular encefálico, trombose de stent ou revascularização miocárdica de urgência, foi de 3,2%. A incidência acumulada de sangramento grave e complicações vasculares foi de 3,2%. Não houve casos de trombose do cateterguia ou oclusão abrupta do vaso. A ICP em pacientes com síndrome coronária aguda em uso de fondaparinux associase a baixas taxas de eventos cardiovasculares adversos isquêmicos e de complicações hemorrágicas graves. A suplementação com heparina não fracionada durante o procedimento invasivo elimina o risco de trombose do cateter.

Downsizing – the Future of Interventional Cardiology

The concept of downsized catheters (i.e., using catheters smaller than 6 French) for invasive coronary procedures, such as diagnostic cardiac catheterisation and percutaneous coronary intervention, has been developing over the years, particularly as a result of the rise of the transradial approach. Recent advances have allowed the use of smaller and sheathless catheters, which confer a number of advantages – such as fewer vascular complications, reduced use of contrast agent and reduced haemostasis – thus increasing patient safety and comfort and allowing more rapid patient mobilisation. Reductions in patient complications, number and length of hospital stay, and amount of contrast agent used can also lead to cost savings. While the use of smaller catheters has been hindered in the past because of poor angiographic image quality, new automated contrast injectors have helped overcome this limitation. There is a need to make interventional cardiologists worldwide more aware of the benefits of downsizing, in the light of the latest technical developments and the increased use of transradial approach.

Improving in-hospital mortality in elderly patients after acute coronary syndrome—A nationwide analysis of 97,220 patients in Taiwan during 2004–2008

BackgroundElderly patients seem to have especially poor outcomes after acquiring acute coronary syndrome (ACS). We conducted this study to examine the in-hospital mortality by utilization of invasive coronary therapies and age in a nationwide population in Taiwan. MethodsThis observational study was conducted on a retrospective cohort from January 2004 to December 2008.Epidemiological features, including incidence rate and clinical characteristics of ACS in a Chinese population were investigated. Risk factors of in-hospital mortality, including myocardial infarction, shock, previous history of stroke, chronic kidney disease, diabetes mellitus, congestive heart failure, pneumonia, chronic obstructive pulmonary disease, dementia, peripheral arterial occlusive disease, septicemia and the use of invasive coronary procedures, were explored using a logistic regression model. ResultsA total of 97,220 patients were enrolled, and 53.6% of them were elderly. A significant decrease in the utilization rate of invasive coronary therapies (diagnostic coronary angiography and PCI) and increased in-hospital mortality (p<0.001) were observed as patient age increased. Adjusted multivariate logistic regression analysis revealed that the impact of PCI in reducing in-hospital mortality is consistent across age groups, including those older than 75years old. ConclusionsOur nationwide study provides evidence that PCI is associated with significant improvement of in-hospital mortality in patients with ACS. Even the very elderly patients could benefit from PCI. However, currently the utilization rate of PCI in the aging population still does not present enough. A prospective study is indicated to corroborate the findings of this study.

Robotically Assisted Coronary Endarterectomy

Robotic assistance has enabled coronary artery bypass surgery to be performed safely in a completely endoscopic fashion, but diffusely diseased target vessels may pose a technical challenge. We present a case in which coronary endarterectomy was performed on the left anterior descending coronary artery during a two-vessel totally endoscopic coronary artery bypass procedure. A 52-year-old woman presented with intermittent substernal pain. Preoperative studies showed diffuse disease in the left coronary artery system. Bilateral internal mammary arteries were harvested robotically using a skeletonized technique in a completely endoscopic fashion. Cardiopulmonary bypass was achieved via peripheral cannulation, and the heart was arrested with intermittent cold antegrade hyperkalemic blood cardioplegia delivered via an ascending aortic occlusion balloon catheter. The first obtuse marginal anastomosis was performed. The left anterior descending coronary artery was diffusely diseased and heavily calcified. An end-to-side anastomosis was attempted to the right internal mammary artery with unsatisfactory results. A localized coronary endarterectomy was performed, and an extended anastomosis was completed using the right internal mammary artery. The patient recovered uneventfully and was discharged home on postoperative day 6. Diffuse coronary artery disease was once thought to be a prohibitive challenge for minimally invasive coronary bypass procedures. This case demonstrates that local coronary endarterectomy is feasible and safe in robotic totally endoscopic coronary artery bypass surgery.

Trends in the use of diagnostic coronary angiography, percutaneous coronary intervention, and coronary artery bypass graft surgery across North Carolina

Although variation in use of invasive coronary procedures has been shown, the relationship between invasive diagnostic cardiac catheterization (Cath) and subsequent revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) is not known. We evaluated the temporal trends and variation in invasive Cath, PCI, and CABG across hospital systems in North Carolina. All Cath, PCI, and CABG procedures performed in North Carolina from 2003 to 2009 were identified using data reported in the annual North Carolina State Medical Facilities Plan. Rates and variation in procedure use, relative rates of PCI to Cath, CABG to Cath, and CABG to PCI were compared over the study period between hospitals that performed at least 25 Cath, 25 PCI, and 25 CABG procedures. The rates of all invasive procedures per 100,000 population declined: 24% for Cath, 16% for PCI, and 35% for CABG. However, the relative rate of PCI to Cath over the study period increased by 11%, whereas the relative rate of CABG to Cath decreased by 13%. Hospital level analysis showed significant variation in the relative rate of both PCI to Cath (10%-90%, P < .05) and CABG to Cath (5%-35%, P < .05). Although the use of all invasive cardiac procedures declined, the relative rate of PCI to Cath increased over the study period. There was also significant variation in the mode of revascularization (CABG and PCI) across hospital systems in North Carolina. Further research is needed to understand drivers of coronary revascularization.

Contrast induced nephropathy in patients with pre‐existing renal impairment undergoing invasive coronary procedures — a long‐term follow‐up

Medical Journal of AustraliaVolume 195, Issue 5 p. 268-269 Letter Contrast induced nephropathy in patients with pre-existing renal impairment undergoing invasive coronary procedures — a long-term follow-up Akash Dhawan, Akash Dhawan Advanced Trainee in Cardiology Liverpool Hospital, Sydney, NSW.Search for more papers by this authorDevang Parikh, Devang Parikh Cardiology Fellow Liverpool Hospital, Sydney, NSW.Search for more papers by this authorIbrahim Shugman, Ibrahim Shugman Research Fellow in Cardiology South Western Sydney Clinical School, University of New South Wales, Sydney, NSWSearch for more papers by this authorJohn French, John French Cardiologist Liverpool Hospital, Sydney, NSW.Search for more papers by this authorHisham Hallani, Hisham Hallani Cardiologist Nepean Hospital, Sydney, NSW.Search for more papers by this authorClyne Fernandes, Clyne Fernandes Cardiologist Nepean Hospital, Sydney, NSW.Search for more papers by this authorCraig P Juergens, Corresponding Author Craig P Juergens Cardiologist [email protected] Liverpool Hospital, Sydney, NSW.Correspondence: [email protected]Search for more papers by this author Akash Dhawan, Akash Dhawan Advanced Trainee in Cardiology Liverpool Hospital, Sydney, NSW.Search for more papers by this authorDevang Parikh, Devang Parikh Cardiology Fellow Liverpool Hospital, Sydney, NSW.Search for more papers by this authorIbrahim Shugman, Ibrahim Shugman Research Fellow in Cardiology South Western Sydney Clinical School, University of New South Wales, Sydney, NSWSearch for more papers by this authorJohn French, John French Cardiologist Liverpool Hospital, Sydney, NSW.Search for more papers by this authorHisham Hallani, Hisham Hallani Cardiologist Nepean Hospital, Sydney, NSW.Search for more papers by this authorClyne Fernandes, Clyne Fernandes Cardiologist Nepean Hospital, Sydney, NSW.Search for more papers by this authorCraig P Juergens, Corresponding Author Craig P Juergens Cardiologist [email protected] Liverpool Hospital, Sydney, NSW.Correspondence: [email protected]Search for more papers by this author First published: 05 September 2011 https://doi.org/10.5694/mja11.10368Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume195, Issue5September 2011Pages 268-269 RelatedInformation

Multislice computed tomography angiography in the diagnosis of coronary artery disease

Multislice CT angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease. Rapid improvements in multislice CT scanners over the last decade have allowed this technique to become a potentially effective alternative to invasive coronary angiography in patients with suspected coronary artery disease. High diagnostic value has been achieved with multislice CT angiography with use of 64- and more slice CT scanners. In addition, multislice CT angiography shows accurate detection and analysis of coronary calcium, characterization of coronary plaques, as well as prediction of the disease progression and major cardiac events. Thus, patients can benefit from multislice CT angiography that provides a rapid and accurate diagnosis while avoiding unnecessary invasive coronary angiography procedures. The aim of this article is present an overview of the clinical applications of multislice CT angiography in coronary artery disease with a focus on the diagnostic accuracy of coronary artery disease; prognostic value of coronary artery disease with regard to the prediction of major cardiac events; detection and quantification of coronary calcium and characterization of coronary plaques. Limitations of multislice CT angiography in coronary artery disease are also briefly discussed, and future directions are highlighted.