Referral patterns and findings of patients undergoing CT coronary angiography.

Abstract

Background: Computed tomography coronary angiography (CTCA) is widely used to rule out significant coronary artery disease in patients who present with chest pain, with many international guidelines recommending its use. However, there is a tendency for it to be used indiscriminately.

Objectives: This study aimed to evaluate the requesting patterns of CTCA at our institution and the outcomes of these patients. We also aimed to study the prevalence of coronary anomalies observed in these patients.

Methodology: This was a retrospective study of patients who had undergone a CTCA at Sultan Qaboos University Hospital, Muscat, over 5 years (2019-2023). Information was obtained from the electronic patient records. Data are presented as a number (percentage) or mean ± standard deviation as appropriate.

Results: The CTCAs of 1000 patients (mean age, 51.1 + 13.5 years; 606 or 60.6% male) were analyzed. Chest pain was the main indication for requesting CTCA in 670 patients (67.2%), with breathlessness and palpitations as the other indications in 198 (19.8%) and 110 (11%) patients, respectively. Of the findings, 835 (83.5%) patients had right dominance, 92 (9.2%) had left dominance, and the remainder were co-dominant. Of the congenital abnormalities noted, 25 (2.5%) had abnormal origins (right coronary artery 9, circumflex 9), and 27 had aneurysmal or ectatic vessels. One hundred and fifty-two patients had evidence of >50% stenosis, of which 131 patients (13.1%) subsequently had an angiogram. Of these, 77 (7.7%) had evidence of significant disease and underwent intervention.

Conclusion: CTCA is often requested for indications other than chest pain. The use of CTCA resulted in only a small proportion of patients proceeding for invasive coronary angiography, and helps in triaging patients better.