Cardiology consultation as a gatekeeper prior to cardiac multi-detector computed tomography scan.

Ariel Roguin, Sobhi Abadi, Eduard Ghersin, Ahuva Engel, Rafael Beyar, Shmuel Rispler

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Multi-detector computed tomography has advanced enormously and now enables non-invasive evaluation of coronary arteries as well as cardiac anatomy, function and perfusion. However, the role of cardiac MDCT is not yet determined in the medical community and, consequently, many clinically unnecessary scans are performed solely on a self-referral basis. OBJECTIVES: To prospectively evaluate the role of a cardiologist consultation and recommendation prior to the scan, and the influence on the diagnostic yield of cardiac MDCT. METHODS: In our center a CT service was initiated, but with the prerequisite approval of a cardiologist before performance of the CT. Each individual who wanted and was willing to pay for a cardiac CT was interviewed by an experienced cardiologist who determined whether cardiac MDCT was the most appropriate next test in the cardiovascular evaluation. Subjects were classified into three groups: a) those with a normal or no prior stress test, no typical symptoms and no significant risk factors of coronary artery disease were recommended to perform a stress test or to remain under close clinical follow-up without MDCT; b) those with an equivocal stress test, atypical symptoms and/or significant risk factors were allowed to have cardiac MDCT; and c) those with positive stress test or clinically highly suspected CAD were advised to go directly to invasive coronary angiography. CT findings were categorized as normal CAD (normal calcium score and no narrowings), <50% and > 50% CAD. RESULTS: A total of 254 people were interviewed, and in only 39 cases did the cardiologist approve the CT. However, 61 of the 215, despite our recommendation not to undergo CT, decided to have the scan. Assessment of the 100 cases that underwent MDCT showed a statistically significant better discrimination of significant CAD, according to the cardiologist's recommendation: MDCT not recommended in 3/54 (6%) vs. MDCT recommended in 12/39 (31%) vs. recommended invasive coronary angiography in 4/7 (57%)(P

Original languageEnglish (US)
Pages (from-to)702-706
Number of pages5
JournalThe Israel Medical Association journal : IMAJ
Volume10
Issue number10
StatePublished - Oct 2008
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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