COMPUTED TOMOGRAPHY OF THE CORONARY ARTERIES (CTCA)
Changing the Evaluation and Medical Management of Coronary Artery Disease in the Primary Care Setting
Coronary Heart Disease
Coronary heart disease remains the number one killer of men and women in the developed world. Two thirds of heart attacks occur in the setting of insignificant coronary artery narrowings. Tragically, sudden death is the presenting symptom of coronary artery disease in up to 330 million individuals per year in the U.S. There is now a highly accurate noninvasive test for the early diagnosis of this devastating disease.
The Era of CT Coronary Angiography (CTCA)
CTCA is a noninvasive CT scan that can accurately evaluate the epicardial coronary arteries for atherosclerosis. It detects the type of plaque, soft or calcified and can also accurately assess arterial stenosis and cardiac function (1,2,3,4).
Our Experience
Our CTCA program was initiated in Feb of 2003 utilizing state-of-the-art 16 detector CT scanners with excellent results.
New Technology
Carolinas Medical Center-NorthEast completed the installation of the GE 64 detector VCT scanner in December of 2005, the fastest true 64 detector scanner on the market, ideal for cardiac imaging. With over 3 years of experience performing CTCA, our radiologists can provide the expertise to assist in managing your patients effectively.
What are the benefits of 64 detector technology?
Faster scan times-typical CTCA in 5-7 seconds
Lower IV contrast load, 80-100cc
400 micron resolution
Sensitivity and specificity for 50% stenosis > 90% (1,2,3)
Negative Predictive Value (NPV) of 98% or greater to exclude significant atherosclerotic disease (1,2,3)
What is the preparation?
No caffeine 12 hours prior to the test.
No weight loss pills, energy drinks or pills 12 hrs. prior to test.
NPO 2 hours before the test.
Oral beta blocker before the test to slow and normalize heart rate.
Sublingual nitroglycerin immediately prior to IV contrast administration.
When should you consider ordering the exam?
As the first test to assess the cause of typical or atypical chest pain (7,8)
As an alternative to standard cath in outpatients and in the Emergency Department in the setting of low/intermediate cardiovascular risk (Achenbach, ACC '06, Raff ACC ‘06)
To evaluate the cause of symptoms in patients with known CAD (7,8)
To evaluate chest pain or dyspnea in patients with prior CABG or coronary stent (7,8)
To clarify abnormal or indeterminate stress test results (7,8)
To assess patients with unexplained shortness of breath
Definitive evaluation of coronary anomalies (7,8)
For patients who refuse coronary catheterization (7,8)
Preoperative evaluation prior to non-coronary artery cardiac surgery (7,8)
In patients with strong family history of CAD, parent or sibling with first M.I. prior to age 50
What are the most common ICD-9 Codes that may support medical necessity?(7,8)
Chest pressure/discomfort 786.51
Other chest pain 786.59
Chest pain, precordial 786.51
Chest pain, unspecified 786.50
Shortness of breath 786.05
Angina pectoris 413.0
Other unspecified angina pectoris 413.9
Cardiovascular, abnormal ECG 794.31
Cardiovascular, abnormal function study 794.30
Coronary atherosclerosis 414.0
Coronary atherosclerosis of native coronary artery 414.01
Chronic ischemic heart disease 414.9
Acute pericarditis 420.0
Who should not have the exam?
Patients with atrial fibrillation and frequent ectopy
Large patients with Body Mass Index greater than 40
Patients with dense coronary calcifications with calcium score greater than 1000
Image quality may be compromised in patients with pacemakers
When patient heart rate is above 70 despite maximal beta blocker therapy
Other important information:
1. Current literature estimates sensitivity and specificity of 90% or greater on 16 detector CT scanners for 50% epicardial coronary stenosis(1,2,3,4). This will improve with 64 detector technology
2. CTCA negative predictive value of greater than 98%. A negative test virtually excludes significant epicardial coronary atherosclerosis (1,2,3,4)
How can I schedule an exam or inquire for more information?
To schedule an exam call CMC-NorthEast radiology scheduling at 704-783-1729.
Please check with insurance regarding coverage. Total cost of the exam is approximately $1200.00 if not covered by insurance.
Important References
1.Hoffman et al. Noninvasive Coronary Angiography with Multislice CT. JAMA May 25 2005 Vol. 293, No.20:2471-2478
2. Keuttner et al. diagnostic Accuracy of Multidetector CT Coronary Angiography in Patients with Angiographically Proven CAD. JACC. Vol. 43, No. 5, 2004:123-127.
3. Ropers et al. Detection of Coronary Artery Stenosis with Thin-Slice Multi-Slice Detector Row Spiral CT and Multiplanar Reconstruction. Circulation. 2003:107:664-666
4.Mollet et al. Improved Accuracy with 16-Row Multi-Slice Computed Coronary Angiography. JACC Vol.45, No.1 2005:552-557
5. Arad et al. The St. Francis Heart Study-Coronary Disease Risk Factors, C-Reactive Protein, and Atherosclerotic Cardiovascular Disease Events. JACC, 2005:46:158-165.
6. Berman et al. Relationship Between Stress-Induced Myocardial Ischemia and Atherosclerosis Measured by Coronary Calcium Tomography. JACC. 2004.Vol. 44, No. 4.
7. Model Local Carrier Determination- Cardiac Computed Tomography and Computed Tomography Coronary Angiography. ACC, ACR, SCMR, SNM. Dec. 22, 2005.
8.Medicare Part B Carrier-North Carolina Local Coverage Determination for Computed Tomographic Angiography of the Chest, Heart and Coronary Arteries(L20553) Jan. 8, 2006.
