Links To “5 Pearls on Calcium Scores and Coronary CTAs” From Core IM – An Awesome Podcast

This post contains links to and excerpts from the Core IM podcast of July 10, 2019, 5 Pearls on Calcium Scores and Coronary CTAs:

Time Stamps     Show Notes     Transcript     References

Here are excerpts:

Show Notes

Pearl 1

Pearl 2

Pearl 3

  • Coronary CTA is simply a gated arterial phase contrast CT study that allows us to visualize the coronary arteries.
  • We have randomized trial data that not only are these non-inferior to functional stress testing when it comes to death, myocardial infarction, hospitalization for unstable angina, or major procedural complication.
  • There is the potential to reduce death and non-fatal MI using coronary CTAs over standard care.  
    1. Patients undergoing coronary CTA as opposed to functional stress testing are more likely to be initiated on preventative, mortality-reducing therapies. 
  • Added benefits to coronary CT:
    1. Detect atherosclerotic disease that wouldn’t get picked up on with either stress test or even a  coronary angiogram because it’s also not encroaching on the lumen
    2. Coronary CTA also picks up plaque morphology, such as with thin-cap fibroatheroma or “soft plaques”
    3. Coronary CTAs can also be used to identify congenital anomalies and are routinely done prior to afib ablations to evaluation pulmonary veins and sizing for aortic valves for TAVR.

Pearl 4

  • Avoid coronary CTA in patients with elevated or irregular rates, frequent ectopy, or a history of prior stents. Also, it is generally a poor choice in the elderly or obese. 

Pearl 5

  • Coronary CTAs have a high negative predictive value and therefore, a CCTA without plaque burden can give reassurance that a patient’s symptoms are not from a cardiac source.
  • Coronary CTAs with obstructive coronary lesions, the decision should be made on a case-by-case basis with the cardiologist regarding revascularization and/or optimizing medical therapy.
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