Criteria for Revascularization in Patients with Significant Coronary Artery Disease by CT Angiogram

Introduction: Coronary computed tomography angiography (CT) is a valuable noninvasive tool in the diagnostic work-up of patients with low to intermediate likelihood for coronary artery disease (CAD). Despite the high potential of CT in the characterization of atherosclerotic plaques, there are currently important limitations to the ability of this technique to identify lesions with potential indication for revascularization.
Purpose: Identify criteria for revascularization in patients (pts) who present significant CAD in CT.
Methods: Retrospective, observational, single center study of 1102 consecutive pts submitted to CT. The group of pts with significant CAD by CT (plaques ≥ 50%) or Calcium Score > 400, submitted to invasive coronary angiogram, was studied. Demographic, clinical and tomographic variables were studied in 2 subgroups of pts: submitted to revascularization VS not submitted to revascularization.
Results: A total of 103 pts were studied, 66 males, with a mean age of 63.1±9.7years old. The results between the two groups are shown in the table. After analysis, the only variable that showed a statistically significant association with the need for revascularization was the characteristics of the chest pain (p = 0.02). In the case of patients presenting with typical chest pain, they have a chance of requiring revascularization of 1.9:1, comparing to the pts who refer non-anginal or atypical chest pain (95% CI: 1.30-2.93, p = 0.010).
Conclusions: In our population of pts with significant CAD diagnosed by CT, typical chest pain suggests a chance of revascularization, comparing to atypical and non-anginal pain, of 1.9:1.