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Title: | The utility of coronary computed tomography angiography in elderly patients. | Authors: | Wong D.T.L.;Laggoune J.;Nerlekar N. ;Munnur K.;Ko B.S.H.;Cameron J.D.;Seneviratne S. | Institution: | (Laggoune, Nerlekar, Munnur, Ko, Cameron, Seneviratne, Wong) Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Melbourne, VIC 3168, Australia (Wong) South Australian Health Medical Research Institute, Adelaide, Australia | Issue Date: | 28-Aug-2019 | Copyright year: | 2019 | Publisher: | Science Press (E-mail: yanmh@neigae.ac.cn) | Place of publication: | China | Publication information: | Journal of Geriatric Cardiology. 16 (7) (pp 507-513), 2019. Date of Publication: 2019. | Journal: | Journal of Geriatric Cardiology | Abstract: | Background Coronary computed tomography angiography (CCTA) is often avoided in elderly patients due to a presumption that a high proportion of patients will have heavily calcified plaque limiting an accurate assessment. We sought to assess the image quality, luminal stenosis and utility of CCTA in elderly patients with suspected coronary artery disease (CAD) and stable chest pain. Methods Retrospective analysis of elderly patients (> 75 years) who underwent 320-detector row CCTA between 2012-2017 at MonashHeart. The CCTA was analysed for degree maximal coronary stenosis by CAD-RADS classification, image quality by a 5-point Likert score (1-poor, 2-adequate, 3-good, 4-very good, 5-excellent) and presence of artefact limiting interpretability. Results 1011 elderly patients (62% females, 78.8 +/- 3.3 years) were studied. Cardiovascular risk factor prevalence included: hypertension (65%), hyperlipidaemia (48%), diabetes (19%) and smoking (21%). The CCTA was evaluable in 68% of patients which included 52% with non-obstructive CAD (< 50% stenosis), 48% with obstructive CAD (> 50%) stenosis. Mean Likert score was 3.1 +/- 0.6 corresponding to good image quality. Of the 323 (32%) of patients with a non-interpretable CCTA, 80% were due to calcified plaque and 20% due to motion artefact. Male gender (P = 0.009), age (P = 0.02), excess motion (P < 0.01) and diabetes mellitus (P = 0.03) were associated with non-interpretable CCTA. Conclusion Although CCTA is a feasible non-invasive tool for assessment of elderly patients with stable chest pain, clinicians should still be cautious about referring elderly patients for CCTA. Patients who are male, diabetic and >78 years of age are significantly less likely to have interpretable scans.Copyright © 2019 JGC All rights reserved | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.11909/j.issn.1671-5411.2019.07.006 | ISSN: | 1671-5411 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/36091 | Type: | Article | Subjects: | coronary artery obstruction/di [Diagnosis] major clinical study male observational study percutaneous coronary intervention prevalence retrospective study revascularization smoking thorax pain contrast medium/iv [Intravenous Drug Administration] contrast medium/pv [Special Situation for Pharmacovigilance] glyceryl trinitrate/dt [Drug Therapy] glyceryl trinitrate/pv [Special Situation for Pharmacovigilance] glyceryl trinitrate/li [Sublingual Drug Administration] metoprolol/dt [Drug Therapy] metoprolol/iv [Intravenous Drug Administration] metoprolol/po [Oral Drug Administration] metoprolol/pv [Special Situation for Pharmacovigilance] computed tomography scanner Toshiba Aquilion ONE image quality coronary blood vessel diabetes mellitus female heart catheterization heart rate human hyperlipidemia aged article cardiovascular risk *computed tomographic angiography *coronary angiography coronary artery bypass surgery coronary artery calcification *coronary artery disease/di [Diagnosis] *coronary artery disease/dt [Drug Therapy] *coronary artery disease/su [Surgery] *coronary artery disease/th [Therapy] hypertension diabetes mellitus female heart catheterization heart rate human hyperlipidemia hypertension image quality major clinical study male observational study percutaneous coronary intervention cardiovascular risk retrospective study revascularization smoking thorax pain Article aged prevalence *computed tomographic angiography *coronary angiography coronary artery bypass surgery coronary artery calcification *coronary artery disease / *diagnosis / *drug therapy / *surgery / *therapy coronary artery obstruction / diagnosis coronary blood vessel |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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