17 Coronary angiography in a district general hospital

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Abstract

Introduction

CTCA is now an established diagnostic tool in the evaluation of chest pain, and with the recently up-dated NICE CG95 guidelines its use is likely to increase nationally.1 We aimed to assess the demographics of our local patient cohort, protocol use, radiation dose and the accuracy and outcomes from our CT service.

Methods

Demographic and outcome data was collected for a 17 month period from Jul 2015–Nov 2016. The CTCA result was compared with the invasive angiogram in patients who had both investigations.

Results

689 scans were performed with 95% for rule out of coronary artery disease. 8% of the scan protocols used were calcium scores only, 25% were prospectively ECG triggered spiral acquisition (FLASH), 60% prospective, 4% retrospective and 3% required more than 2 contrast scans. Mean BMI was?29±11 Kgm−2, median DLP 137 mGy*cm (IQR 87–230 mGy*cm), mean acquisition heart rate 61±21 bpm and median IV metoprolol dosage used was 8mg (IQR 0–20 mg). 98% of scans were diagnostic. 11% were referred on for angiography, 88% were recommended medical therapy and 1% were referred for MRI. There was 80% agreement with coronary angiography with 65% proceeding to intervention. 0% of patients who had a negative CTCA required subsequent intervention (before 15/11/16).

Conclusion

Our real-world data demonstrates that CTCA in a district general hospital is an accurate and effective way to rationalise investigations, particularly in the management of coronary artery disease.

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