Links To And Excerpts From “5 Pearls on Calcium Scores and Coronary CTA” From CoreIM

This post contains a link to and excerpts from CoreIM on 5 Pearls on Calcium Scores and Coronary CTAs [Links is to the podcast and complete show notes]. Posted: July 10, 2019
By: Dr. Evan Harmon, Dr. Pamela Douglas, Dr. Greg Katz, Dr. Martin Fried and Dr. Shreya P. Trivedi
Graphic: Dr. Caroline Srisarajivakul-Klein
Audio: Harit Shah
Peer Review: Dr. Aeshita Dwivedi, Dr. Matthew Vorsanger, Dr. Robert Doninno

Here are excerpts:

Time Stamps

  • 3:10     What are the big picture differences of functional stress tests and anatomical cardiac tests?
  • 7:48     What is coronary artery calcium scores’ role in managing coronary artery disease?
  • 16:20   How do coronary CTAs compare to stress tests?
  • 24:28   When should we avoid CTA?
  • 29:33   How do we communicate coronary CTA results with patients?
  • 36:02   Recap

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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