CME 5/12/13: CT Coronary Angiography (CTCA)

 
Here is Sean Lim’s talk on CTCA. Bottom line, still finding it’s place in ED Ix/Mx of low to moderate risk chest pain patients with normal CE’s. Evidence suggests this test has good NPV in this patient group. Given current expertise there are currently only 5 spots / week (?on Wednesday) reserved for OP/IP CTCA at SCGH. There is no current plan for acute CTCA imaging for Ix of appropriate ED patients, although this may discussed with radiology/cardiology, and be considered in the future depending on resources. There is some evidence that incorporation of CTCA into the initial workup of chest pain in patients with intermediate risk may decrease the duration of stay and the rate of admission. However, it appeared to also be associated with an increase in followup testing and had no impact on the total cost of management (Coronary CT Angiography versus Standard Evaluation of Acute Chest Pain: N Engl J Med 2012; 367:299-308, July 26, 2012).