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Abstract Introduction Current indications for coronary artery disease (CAD) evaluation through computed tomography (CT) are well established. Purpose To evaluate the real world experience regarding indications to coronary CT, results and subsequent patient management. Material and methods Single center retrospective analysis of patients´ admitted to perform a coronary CT during 2023. Demographic and clinical characteristics of patients, indications for the CT, exam data and management were recorded. Results 484 patients were included (mean age 67.5 years, 52.2% male). In the first group, 283 (58.4%) patients presented with chest pain and no known CAD. Of these, 47.7% had positive ischemia tests, ventricular repolarization or echocardiographic wall motion abnormalities. The other 52.3% were referred due to chest pain only or despite negative ischemia tests. In the second group, 110 (22.8%) patients were referred to exclude CAD in the presence of other cardiac conditions: valvular heart disease (18.2%), ventricular ectopic beats (22.8%), heart failure (30.0%), cardiac transplantation (10.9%), acute conditions (10%) and congenital heart disease (8.2%). The exams´ results were divided in the following categories: absence of CAD, non-obstructive CAD (stenosis 50%), obstructive CAD (stenosis 50%) or inconclusive (non-assessable left main and/or proximal anterior descending artery or elevated atherosclerotic burden precluding contrast injection). In the first group, 81.6% presented none or non-obstructive CAD, 8.8% obstructive CAD and 9.6% were inconclusive. In the second group, 85.5% presented none or non-obstructive CAD, 7.3% obstructive CAD and 6.9% were inconclusive. Depending on medical decision, some patients with obstructive and inconclusive CAD were referred to coronary angiography (CA). At the present time, 10 patients performed CA, of which 3 was submitted to percutaneous intervention. In the third group, 91 (18.8%) patients were referred to coronary CT to evaluate coronary artery anomalies (CAA) (9.9%) and known CAD, namely, coronary stents (11%), coronary artery bypass grafts (CABG) (69.2%) and to decide surgical revascularization based on an occluded artery in CA (9.9%). Regarding CAA, only 1 patient was diagnosed with a malignant course and submitted to an unroofing procedure. Regarding previously revascularized patients: coronary stents and CABG were adequately evaluated in all proposed patients (only 1 and 2, respectively, presented cclusive lesions and were referred to CA). Of the patients presented with a coronary occlusion on CA, 5 (55.6%) had a good distal vessel so they were referred to surgical revascularization. Conclusion Our data is in accordance with current published studies and guidelines showing that coronary CT is a well stablished exam to safely exclude CAD in a low-intermediate risk population as well as some previously revascularized patients.
Almeida et al. (Thu,) studied this question.