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MEDICAL MANAGEMENT OF NON-OBSTRUCTIVE CORONARY ARTERY DISEASE ON CORONARY CT ANGIOGRAPHY: INSIGHT FROM A MODERN EMERGENCY DEPARTMENT CLINICAL REGISTRY
1763 JACC April 5, 2016 Volume 67, Issue 13
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) MEDICAL MANAGEMENT OF NON-OBSTRUCTIVE CORONARY ARTERY DISEASE ON CORONARY CT ANGIOGRAPHY: INSIGHT FROM A MODERN EMERGENCY DEPARTMENT CLINICAL REGISTRY Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: Cardiac CT Angiography: Prognosis, Plaque and Perfusion Abstract Category: 28. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1230-246 Authors: Nandini Meyersohn, Sumbal Janjua, Pedro Staziaki, Daniel Bittner, Richard Takx, Rory Weiner, Jason Wasfy, Udo Hoffmann, Brian Ghoshhajra, Massachusetts General Hospital, Boston, MA, USA
Background: Coronary CT angiography (CCTA) is an established tool for evaluation of low- to intermediate-risk emergency department (ED) patients with acute chest pain. We evaluated the medical management of patients diagnosed with previously unknown nonobstructive coronary artery disease (CAD) in the ED.
Methods: The study population included 160 patients who underwent CCTA in the ED between 1/2014 and 2/2015 and were diagnosed with CAD resulting in mild (1-49%) stenosis. Medical records were reviewed for medication therapy prior to the index visit, initiation during the index visit, and initiation at follow-up visit.
Results: The overall baseline rate of statin therapy was 27% and aspirin therapy was 28%. At the time of index discharge, statin therapy was initiated for 6 patients (4%) and aspirin therapy for 13 patients (8%). Follow-up information was available for 88 patients (55%) within 8 months of the index visit. 20 patients (13%) followed up with a cardiologist and 67 patients (42%) followed up with a primary care physician. For the subset of patients with follow-up information, the rate of statin therapy increased from 33% to 53% and the rate of aspirin therapy increased from 42% to 60%. Conclusions: A new diagnosis of non-obstructive CAD on CCTA in the ED led to an increased rate of medical therapy. There remains a missed opportunity, however, for physicians to tailor preventive medical therapy based on the actual presence of CAD in addition to current guidelines based on risk factor assessment. Medical therapy for subset of patients with non-obstructive CAD and follow-up information available Statin therapy
Aspirin therapy
Baseline
33% (29/88)
42% (37/88)
At index discharge
38% (33/88)
50% (44/88)
After follow-up visit
53% (47/88)
60% (53/88)
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) MEDICAL MANAGEMENT OF NON-OBSTRUCTIVE CORONARY ARTERY DISEASE ON CORONARY CT ANGIOGRAPHY: INSIGHT FROM A MODERN EMERGENCY DEPARTMENT CLINICAL REGISTRY Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: Cardiac CT Angiography: Prognosis, Plaque and Perfusion Abstract Category: 28. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1230-246 Authors: Nandini Meyersohn, Sumbal Janjua, Pedro Staziaki, Daniel Bittner, Richard Takx, Rory Weiner, Jason Wasfy, Udo Hoffmann, Brian Ghoshhajra, Massachusetts General Hospital, Boston, MA, USA
Background: Coronary CT angiography (CCTA) is an established tool for evaluation of low- to intermediate-risk emergency department (ED) patients with acute chest pain. We evaluated the medical management of patients diagnosed with previously unknown nonobstructive coronary artery disease (CAD) in the ED.
Methods: The study population included 160 patients who underwent CCTA in the ED between 1/2014 and 2/2015 and were diagnosed with CAD resulting in mild (1-49%) stenosis. Medical records were reviewed for medication therapy prior to the index visit, initiation during the index visit, and initiation at follow-up visit.
Results: The overall baseline rate of statin therapy was 27% and aspirin therapy was 28%. At the time of index discharge, statin therapy was initiated for 6 patients (4%) and aspirin therapy for 13 patients (8%). Follow-up information was available for 88 patients (55%) within 8 months of the index visit. 20 patients (13%) followed up with a cardiologist and 67 patients (42%) followed up with a primary care physician. For the subset of patients with follow-up information, the rate of statin therapy increased from 33% to 53% and the rate of aspirin therapy increased from 42% to 60%. Conclusions: A new diagnosis of non-obstructive CAD on CCTA in the ED led to an increased rate of medical therapy. There remains a missed opportunity, however, for physicians to tailor preventive medical therapy based on the actual presence of CAD in addition to current guidelines based on risk factor assessment. Medical therapy for subset of patients with non-obstructive CAD and follow-up information available Statin therapy
Aspirin therapy
Baseline
33% (29/88)
42% (37/88)
At index discharge
38% (33/88)
50% (44/88)
After follow-up visit
53% (47/88)
60% (53/88)