A Clinical Study on Role of Coronary Computed Tomography Angiogram in the Diagnosis of Coronary Artery Disease

Abstract

Background: In the recent past, cardiac computed tomography (CT) angiography is being performed for the diagnosis and treatment of coronary artery disease (CAD) and congestive heart failure. The differentiation of ischemic from non-ischemic cardiomyopathy, characterization of hypertrophic cardiomyopathy, and delineation of congenital heart defects are its primary diagnostic applications.
Aim of the Study: The aim was to study the clinical applications of coronary CT angiography (CCTA) in patients with suspected CAD and identify factors that affect CCTA findings.
Materials and Methods: Two hundred and fourteen patients diagnosed with CAD were included in the study. Patients aged between 36 and 76 years were included. Patients with chest trauma and prior thoracic surgery (coronary stenting or coronary artery bypass grafts) were excluded. Demographic data of the patients were recorded including age, gender, blood pressure, body mass index, smoking habits, intake of alcohol, previous history of angina, diabetes, and hypertension were recorded. The duration of symptoms was classified into five groups: <1 week, 1 week to 1 month, 1–3 months, 3–6 months, and more than 6 months. All the patients were investigated with lipid profile, serum creatinine, and blood glucose levels. All the patients were subjected to CCTA. The percentage of abnormal CCTA was observed and recorded. Abnormality of coronary arteries was expressed as atherosclerotic changes identified on CCTA scans, which is reflected in either an involvement of the right coronary artery (RCA), or the left coronary artery (LCA), or both of RCA and LCA. Significant coronary stenosis indicates that more than 50% lumen stenosis due to the presence of plaques was considered.
Observations and Results: Two hundred and fourteen patients with diagnosed CAD were included in the study, aged between 36 and 76 years. The mean age was 56 ± 2.10 years. There were 153 (71.49%) males and 61 (28.50%) were female, with a male-to-female ratio of 3.44:1. The youngest patient was aged 37 years and the eldest patient was 75 years with a mean age of 56 ± 2.10 years. There were 114/214 (53.27%) patients with abnormal CCTA scans and among them 84/114 (73.68%) were male and 30/114 (26.31%) were female. The most common symptom of presentation was pain in the chest elicited in 139 (64.95%) of the patients in this study, followed by history of hypertension in 89 (41.58%) patients. It was observed that there was no significant difference in the percentage of abnormal CCTA findings between male and female patients (P = 0.19), (with P value taken as statistically significant at <0.05). Similarly, no significant difference was found between the sex (male/female) and duration of symptoms (P = 0.71).
Conclusions: CCTA is a non-invasive, outpatient-based procedure suitable in patients without actionable CAD, obviating unnecessary invasive examination of coronary vessels. CT angiography findings are directly related to patient age and duration of symptoms, with increased abnormal findings reported in elderly population with the duration of symptoms more than 6 months. Moreover, there was a direct correlation between the involvement of coronary arteries and the patient age.