CT Coronary Angiography (CTCA)

1. CT Coronary Angiogram
(CTCA)

2. What is it?

Use of Computed Tomography to image a beating heart

Non invasive

Good visualisation of the coronary vessels

Provides useful diagnostic information regarding coronary
artery disease (CAD)

3. Conjoint Committee for Recognition
of Training in CTCA

Body that governs specialists in Australia and New
Zealand who report CTCA

Radiologist, Cardiologists and Nuclear Medicine
Physicians

Complete requisite training criteria

Level A: 150 live and library cases (300 cases every 3 years)

Level B: 300 live and library cases (600 every 3 years)

4. Why Refer for a CTCA

Examination of coronary artery that is

Low risk

Low radiation

Non invasive

5. Why Refer for a CTCA

Accurately detect and grade stenosies or narrowing

Demonstrate developmental anomalies of cornary vessels

Check patency of existing grafts

6. Patients who would benefit…

Suspected CAD

Presents with atypical chest pain

Coronary artery anomaly

Asymptomatic atherosclerosis with known CAD

Post by-pass surgery patients

7. Indications

Based on Framingham criteria (risk score), previous
nuclear and stress echocardiogram or coronary
angiography

Framingham criteria is a risk score assessment tool based
on a study of

11,611American patients

20-76 years

No self reported CAD, stroke, peripheral arterial dusease
or diabetes

8. Indications

Framingham criteria/risk score is based on:

Age

Total cholesterol

HDL cholesterol

Smoking history

Systolic blood pressure

9. Indications

Results

82% Low: 10% of less CAD risk at 10 years

16% Intermediate: 10-20% CAD risk at 10 years

3% High: More than 20% CAD risk at 10 years

High risk category mainly contained advanced age and
male gender

Risk calculator available on internet

10. Indications

Chest pain (Low to intermediate pre test probability)

CABG and stents (stent length <3mm)

Cardiac conditions

Non coronary valvular surgery

Unexplained heart failure and arrythmias

Coronary anomalies

AF Ablation

Early detection/screening

11. Rebatable Indications for
CTCA

Stable symp;toms consistent with coronary ischaemia, low
to intermediate risk or CAD, people who have been
considered for coronary angiography

Undergoing non-coronary cardiac surgery

Exclusion of artery anomaly

12. Comparison of CTCA with Selective Coronary
Angiography (>50% luminal stenosis)
n
CAD
Prevelance
Sensitivity
Specificity
PPV
NPV
ACCURAC
Y
230
25%
95%
83%
64%
99%
CORE64
291
56%
85%
90%
91%
83%
Dutch Study
360
68%
99%
64%
86%
97%

13. Patient Preparation…

Withould caffeine from midnight prior to examination

4hr fast

BP and HR measurement

If HR >60-65bpm : betablocker

ECG monitoring (gated study)