Download Free Medical Cardiac CT in the Emergency Room PowerPoint Presentation

Cardiac CT in the Emergency Room PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Cardiac CT in the Emergency Room

Tags : Chest pain, Cardiac CT, CT coronary angiography

Published on : Mar 16, 2023 | Views : 535 | Downloads : 4

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

CARDIAC CT New Approach to Cardiovascular Disease Stephen Fleet, M.D.
Slide 2-

A picture is worth 1000 words
Slide 3-

MESA Study – 6,814 Patients: 3.5 year follow-up Fully adjusted – Detrano et al– NEJM 2008 Ref Nonfatal MI & CHD Death 4.47 (2.45,8.13) 10.26 (5.62,18.71) 14.13 (7.91,25.22)
Slide 4-

ppt slide no 4 content not found
Slide 5-

<10% 10-20 >20 % 10-year risk ATPIII Score Risk Assessment CAC Score high Intermediate Zero Reclassification of ATP III Risk Categories Using CAC Scheme according to Wilson PWF et al JACC 41:1889 – 1906, 2003 with HNR data
Slide 6-

MESA – Aspirin Use 2018
Slide 7-

15 Year WarrantyValenti, Min Callister 2015
Slide 8-

CAC Zero as Negative Risk Marker
Slide 9-

ST FRANCIS RANDOMIZED TRIALRandomized Double Blind Placebo Controlled Trial of Atorvastatin in the Prevention of Cardiovascular EventsAmong Individuals With Elevated CAC Score Arad Y et al. J Am Coll Cardiol 2005: 46: 166-172. Atorvastatin 20 mg (N=490) MI Stroke CVD Death CABG/PTCA No Prior CVD Men, Women 50-70 years CAC >80% of age-gender Placebo (N=515) Mean duration of treatment was 4.3 years. Treatment reduced low-density lipoprotein cholesterol by 40%, while reducing clinical endpoints by 30% (6.9% vs. 9.9%), and MI/ Death by 44% (NNT = 30) Event rates were more significantly reduced in participants with baseline calcium score >400 (8.7% vs. 15.0%, p=0.046 [42% reduction]). NNT = 15.8
Slide 10-

Does CAC scanning improve outcomes? Rozanski. Berman. EISNER. JACC 2011;57:1622. CACS 0 = 631. CACS>400 = 109.
Slide 11-

“assessing CAC is likely to be the most useful of the current approaches to improving risk assessment among individuals found to be at intermediate risk after formal risk assessment.” ACC/AHA 2013 PREVENTION GUIDELINES– Goff JACC 2014
Slide 12-

ppt slide no 12 content not found
Slide 13-

CAC IN 2018 GUIDELINES
Slide 14-

MESA STUDY 10 year outcomes Budoff EHJ 2018
Slide 15-

NNT for CAC >100 12
Slide 16-

Case presentation 41 year old male presented with intermittent chest pain for <1 day with associated nausea/vomiting/back pain. Initially assessed as intermediate risk for ACS History only remarkable for smoking Non-diagnostic ECG; unremarkable exam/labs Initial Troponin was .048 Patient was taken for cardiac CT
Slide 17-

ppt slide no 17 content not found
Slide 18-

ppt slide no 18 content not found
Slide 19-

ppt slide no 19 content not found
Slide 20-

ppt slide no 20 content not found
Slide 21-

Guidelines SCCT guidelines on the use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergencydepartment: A Report of the Society of Cardiovascular Computed Tomography Guidelines Committee Raff et al. JCCT June 2014
Slide 22-

ppt slide no 22 content not found
Slide 23-

ppt slide no 23 content not found
Slide 24-

Figure 1 Study Algorithm In this diagnostic algorithm, patients in the multi-slice computed tomography (MSCT) group with normal scans were eligible for immediate discharge. Patients with severe stenosis on MSCT (over 70%) were referred for invasive angiog... James A. Goldstein , Michael J. Gallagher , William W. O’Neill , Michael A. Ross , Brian J. O’Neil , Gilbert L. Ra... A Randomized Controlled Trial of Multi-Slice Coronary Computed Tomography for Evaluation of Acute Chest Pain Journal of the American College of Cardiology, Volume 49, Issue 8, 2007, 863 - 871 http://dx.doi.org/10.1016/j.jacc.2006.08.064
Slide 25-

Figure 1 Study Algorithm Coronary computed tomographic angiography (CCTA) arm (orange) : *invasive coronary angiography = 24 patients (18 = abnormal CCTA, 3 = abnormal myocardial perfusion imaging [MPI], 3 = physician discretion). MPI = 37 patients (24 =... James A. Goldstein , Kavitha M. Chinnaiyan , Aiden Abidov , Stephan Achenbach , Daniel S. Berman , Sean W. Hayes ,... The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) Trial Journal of the American College of Cardiology, Volume 58, Issue 14, 2011, 1414 - 1422 http://dx.doi.org/10.1016/j.jacc.2011.03.068
Slide 26-

CT-STAT 2011 No missed ACS
Slide 27-

ROMICAT-II (Hoffman et al, NEJM 2012) - Notable differences to the prior randomized studies: -TIMI scores did not limit entry criteria - SOC included any available management strategy deemed appropriate by the treating physicians. These choices included EKG treadmill testing, stress echo and stress single photon emission CT, as well as no further diagnostic testing
Slide 28-

ppt slide no 28 content not found
Slide 29-

ppt slide no 29 content not found
Slide 30-

ppt slide no 30 content not found
Slide 31-

ppt slide no 31 content not found
Slide 32-

ppt slide no 32 content not found
Slide 33-

ppt slide no 33 content not found
Slide 34-

ppt slide no 34 content not found
Slide 35-

CT-Compare Hamilton-Craig et al. International Journal of Cardiology 177 (2014) 867–873
Slide 36-

ppt slide no 36 content not found
Slide 37-

ppt slide no 37 content not found
Slide 38-

ppt slide no 38 content not found
Slide 39-

ppt slide no 39 content not found
Slide 40-

ppt slide no 40 content not found
Slide 41-

ppt slide no 41 content not found
Slide 42-

ppt slide no 42 content not found
Slide 43-

ppt slide no 43 content not found
Slide 44-

ppt slide no 44 content not found
Slide 45-

ppt slide no 45 content not found