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Incidence and Management of Mild Coronary Atherosclerotic Disease Diagnosed with Coronary CTA in the Emergency Department

Kim Lori Sandler, Candace D McNaughton, Marcus A Presley and Jennifer R Williams

Introduction: Coronary computed tomography angiography (CTA) is an excellent tool for the evaluation of chest pain in patients with a low likelihood of having acute coronary syndrome. Patients with mild coronary disease are easily identified with coronary CTA in contrast to imaging studies that detect only hemodynamically significant stenosis. This study was designed to evaluate 1) the incidence mild coronary artery disease diagnosed by CTA and 2) the challenge of managing these patients in the emergency department setting.
Methods: A retrospective review was performed of coronary CTA examinations requested by ED physicians over three years. Imaging results were stratified as being negative, representing mild disease, and representing moderate to severe disease. Patients with mild disease were further evaluated to determine if the patient 1) had known CAD prior to the CTA, 2) was on or was prescribed a statin, 3) had a positive family history, 4) had a smoking history, 5) was diabetic, and 6) was scheduled for follow-up with Cardiology following discharge from the ED.
Results: A total of 140 coronary CTA examinations were performed on patients in the Emergency Department over a three-year period, with 137 meeting inclusion criteria. Of these, 109 studies were negative for coronary artery disease, 8 had significant CAD with greater than 50% luminal narrowing, and 20 demonstrated mild CAD without significant stenosis (age range 41-65 years with mean age of 50.2). Conclusion: Coronary CT angiography is highly accurate for the detection of coronary artery disease and has proven to be an excellent tool for the evaluation of patients with chest pain and a low pre-test probability of having acute coronary syndrome. Patients diagnosed with mild disease present a challenge to emergency department physicians as they do not require immediate intervention, but can benefit greatly from therapies designed to prevent future coronary events.