G. KOULAOUZİDİS, A. POWELL, T. MCARTHUR, P.J .JENKİNS, D. Brennand ROPER

Computed tomography coronary angiography as initial work-up for unstable angina pectoris

Bilgisayarlı tomografi koroner anjiyografi (BTKA) koroner arter hastalığı (KAH) için non invazif hızlı bir araştırma aracıdır. 2000 yılında Birleşik Krallıkta (UK) göğüs ağrısı olan hastalara hızlı bir şekilde yardımcı olmak için hızlı ulaşılan göğüs ağrısı klinikleri (RACPC) kurulmuştur. Çalışmanın amacı birinci basamak tabanlı RACPC de unstable anjina pektoris için başlangıç work-up olarak BTKA kullanımını araştırmaktı. Seksen sekiz (n=88) hasta bir konsultan kardiyolog tarafından muayene edildi ve eğer endikasyon varsa BTKA çekildi. BTKA bir 640 slices, 320 row BT skaner ile uygulandı. Otuz beş (n=35) daha ileri araştırma yapılmadan ta- burcu edildi. 50 (ortalama yaş 59.8 yıl;24 erkek) hastaya BTKA çekildi ve 3 hasta doğrudan invazif anjiyografiye (IA) gönderildi. BTKA sonrası 17 hasta taburcu edildi. KAH öyküsü olmayan, fakat pozitif BTKA si olan 17 hasta ve bilinen KAH öyküsü olan fakat BTKAsinde yeni lezyon saptanmayan 11 hasta medikal tedavisi düzenlenerek taburcu edildi. Elli hastanın 5ine IA yapıldı, 2si CABGya yönlendirildi, 3ünde medikal tedavi ile devam edildi. 6 aylık takip periyodu sonrası herhangi bir majör yan etki kaydedil- medi. BTKA yapılan her hastanın maliyeti £1,087idi; hastaların %94ü deneyimlerini iyi veya mükemmel olarak derecelendirdiler. RACPC başvurusu ile kesin tanı arasındaki zaman aralığı hastaların %50sinde

Unstable anjina pektoris için başlangıç work-up olarak bilgisayarlı tomografi koroner anjiyografi

Computed Tomography Coronary Angiography (CTCA) is a rapid, non-invasive diagnostic tool for coronary artery disease (CAD). Rapid Access Chest Pain Clinics (RACPC) were introduced in UK in 2000, in order to assess rapidly patients with chest pain. To eval- uate the use of CTCA as initial work-up for unstable angina pectoris in a primary care-based RACPC. Eighty-eight (n=88) patients were examined by a consultant cardiologist and referred for CTCA if indicated. CTCA was performed with a 640 slices, 320-row CT scanner. Thirty-five (n=35) patients were discharged without further investigations; 50 (mean age 59.8 years; 24 male) were referred for CTCA and 3 were referred directly for an invasive angiography (IA). Following CTCA, 17 patients were discharged. Seventeen (n=17) patients with no history of CAD, but with positive CTCA findings and eleven (n=11) patients with known CAD but without new lesions on CTCA were discharged after optimisation of medical treatment. Five (n=5) of the 50 patients eventually underwent IA; 2 were referred for CABG; 3 continued with medical treatment. No major adverse cardiac events were recorded in a 6-months follow up period. The cost for each patient who underwent CTCA was £1,087; 94% of patients rated their experience as good or excellent. The time interval from RACPC visit-to-definitive diagnosis was

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