key: cord-0749262-7lzguxv6
authors: Gray, R.; Ellenburger, K.; Friedman, D.; Yu, J.; Cranney, G.
title: Expedited Outpatient CTCA for Intermediate Risk Chest Pain During the COVID-19 Pandemic
date: 2021-12-31
journal: Heart, Lung and Circulation
DOI: 10.1016/j.hlc.2021.06.211
sha: abae40b460c4780296e3f070cfae7fc9d04a5c71
doc_id: 749262
cord_uid: 7lzguxv6

nan

Background: The COVID-19 pandemic resulted in many changes to clinical practice with a view to protecting hospital resources and utilisation of remote models of care. A new pathway was established at our centre to discharge patients from ED presenting with intermediate risk chest pain with arrangements made for an expedited outpatient CTCA. The aim of this study is to assess the safety and efficacy of this approach.

Methods: Prospective single centre observational study of patients with intermediate risk ACS and no contra-indications to CTCA, discharged from ED over a three-month period with expedited outpatient CTCA and follow-up. We collected baseline patient characteristics, CTCA findings, need for subsequent invasive angiography/revascularisation, commencement of statin therapy and 30-day ED representation, non-fatal MI, and all-cause mortality.

Results: 39 patients were included in the study. Mean time from presentation to CTCA was 4.06 days (1-11). Average patient age was 58 (37-83), with a mean HEART score of 3.13. (2) (3) (4) (5) . 6% (n=2) of patients were found to have severe stenosis of one or more coronary arteries, with 22% (n=8) found to have moderate (50-69%) stenosis. 17% (n=6) underwent invasive angiography with 6% (n=2) requiring PCI and 3% (n=1) requiring CABG. 36% (n=13) were newly commenced on statin therapy. There was 1 hospital representation and no 30day non-fatal MI or mortality.

Conclusion: A new urgent outpatient pathway for intermediate risk ACS was found to be safe in this small prospective trial demonstrating it may be an acceptable model of care with potential to reduce ED and hospital length of stay. Background: Despite increased uptake of Cardiac Computerised Tomography (CCT) in evaluation of chest pain, there is ongoing perceived limitations in non-ideal patients (pts) defined as older, obese, anxious and pacemaker, and atrial fibrillation patients.

Methods and Results: This study evaluated 190 consecutive patients referred for CCT at RAH between May 2020 and February 2021 (Siemens Force DS scanner), 53.2% male, mean age 54.6(+/-13) years, radiation dose 3.03(+/-2.1) mSv and average heart rate(HR) 61.0(+/-9.9) bpm. A poor scan (SCCT grade 4) occurred in 22 (1.9%), resulting in 12 repeated scans, 11 of which were diagnostic and 2 required alternative testing. 2 patients had AF, 34 (17.9%) were obese, 28(14.7%) . 70 years, 58(30.5%) anxious and 4 patients had a pacemaker. Univariate and multivariate analysis, for HR, BMI, anxiety. lung disease, age and calcium score were not predictive of a poor scan. Prescan HR controlling medication occurred in 161pts (79.5%) but additional oral therapy was required in 28(14.7%) and intravenous in 36(18.9%). Poor scans were due to sudden change in HR in 8, patient factors/ movement 8, calcium 3, pacemaker artifact 2, and no reason identified in 3 patients. The clinical question was answered in 187 (98.4%). Additional testing occurred in 13.2% and 10.0% were for critical disease. CTCA avoided invasive coronary angiography in 12 patients (6.3%), Complications occurred in 2 patients-syncope 1, dye extravasation 1. Significant coincidental findings occurred in 4.7%.

Conclusion: In conclusion, in this unselected population including 56.3% with non-ideal features, the incidence of a poor scan was low, and diagnostic yield very high, with excellent safety performance. 

5-Year outcomes after transcatheter aortic valve implantation with CoreValve prosthesis

Leaflet thrombosis after TAVI

Transcatheter aortic valve thrombosis

Cusp thrombosis after transcatheter aortic valve replacement detected by computed tomography and echocardiography

Late coronary ischemıc syndromes assocıated wıth transcatheter aortıc valve ımplantatıon: A revıew of mechanıstıc and clınıcal aspects