> What will be the consequences of screening these patients in
> terms of cost,
> radiation dose, complications of false positive CTCAs leading
> to coronary
> angiography and so on...
> ...so what are we to do in the 30
> year old patient
> with high coronary artery Ca2+ score who has low risk chest
> pain to start
> with?
Also incidental findings. Much of the work comes from the US where they seem to have a somewhat more blase approach to irradiation than in the UK. I also get the feeling from a lot of papers that (possibly related to item of service for radiologists) picking up incidental findings that need further investigation is seen as a good thing.
In terms of cost there was a recent analysis showing it slightly cheaper than the usual chest pain unit protocols.
The radiation dose of a CCTA is about 10- 25 mSv, but newer machines and techniques have dropped this to 3 mSv (i.e. a year's worth of background radiation). Regarding false postives, CTCAs don't give a calcium score, they measure the degree of stenosis. Severe stenosis has a PPV of around 80%; normal is a true negative; and there are a group of patients in the middle (including a lot of false postives) where you fall back on what you would have done otherwise. The idea is that you save time and money by discharging the majority of patients with normal arteries within a couple of hours of them coming through the door.
I'd think the age cut offs might vary by ethnicity (including what part of Britain you are in)
Matt Dunn
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