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J Cardiovasc Comput Tomogr. 2015 May-Jun;9(3):193-201. doi: 10.1016/j.jcct.2015.02.006. Epub 2015 Feb 18.

Potential for coronary CT angiography to tailor medical therapy beyond preventive guideline-based recommendations: insights from the ROMICAT I trial.

Author information

1
Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA; Cardiology Division, Evanston Hospital, Walgreen Building 3rd Floor, 2650 Ridge Ave, Evanston, IL 60201, USA. Electronic address: apursnani@northshore.org.
2
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
3
Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA.
4
Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
5
Department of Clinical Radiology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany.
6
Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
7
Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114, USA; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, Weill Cornell Medical College, NY, USA.

Abstract

BACKGROUND:

Coronary CT angiography (CCTA) is used in the emergency department to rule out acute coronary syndrome in low-intermediate risk patients.

OBJECTIVES:

We evaluated the potential of CCTA to tailor aspirin (ASA) and statin therapy in acute chest pain patients.

METHODS:

We included all patients in the ROMICAT I trial who underwent CCTA before admission. Results of CCTA were blinded to caretakers. We documented ASA and statin therapy at admission and discharge and determined change in medications during hospitalization, agreement of discharge medications with contemporaneous guidelines, and agreement with the presence and severity of coronary artery disease (CAD) as determined by CCTA.

RESULTS:

We included 368 patients (53 ± 12 years; 61% male). Baseline medical therapy at presentation included 27% on ASA and 24% on statin. Most patients who qualified for secondary prevention were on ASA and statin therapy at discharge (95% and 80%, respectively), whereas among those qualifying for primary prevention therapy, only 59% of patients were on aspirin and 33% were on statin at discharge. Excluding secondary prevention patients, among those with CCTA-detected CAD, only 66/131 (50%) were on ASA at discharge and only 53/131 (40%) were on statin. Conversely, in those without CCTA-detected CAD, 54/156 (35%) were on ASA and 20/151 (13%) were on statin at discharge.

CONCLUSION:

There are significant discrepancies between discharge prescription of statin and ASA with the presence and extent of CAD. CCTA presents an efficient opportunity to tailor medical therapy to CAD in patients undergoing CCTA as part of their acute chest pain evaluation.

KEYWORDS:

Aspirin; Coronary CT angiography; Coronary artery disease; Guidelines; Prevention; Statin

PMID:
25846248
DOI:
10.1016/j.jcct.2015.02.006
[Indexed for MEDLINE]

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