201 Computed tomography cardiac angiography (CTCA) changes the management of stable chest pain patients – a single centre experience

Introduction Computed Tomography Cardiac Angiography (CTCA) is now the first-line recommended investigation as per the NICE in new-onset stable chest pain patients. European and International guidance however still recommends risk stratification and functional testing in high and intermediate risk individuals. Methods We performed a retrospective review of stable chest pain patients who had a CTCA on an outpatient basis between January – March 2023. Data was collected using a pre-designed proforma, demographic data, risk factor profile including QRISK, indication for scan, CTCA result and outcome following scan were collected. Statistical analysis was performed using Microsoft Excel software; unpaired t-testing was used to evaluate statistical significance. Results 99 patients were included in this retrospective review 49/99 (49%) patients were male, median age was 57 years. Most common co-morbidities included hypertension (28%), hyperlipidaemia (34%). Median QRISK3 score was 7.8% (table 1) The most common reason for referral for CTCA was atypical chest pain in 75/99 (76%) patients. Mean Calcium score was 41. All patients with severe coronary stenosis (>70%) identified on CTCA proceeded to have LHC+/-PCI. CTCA changed patient management in most cases, in 34/99 cases it led to a change in medication regime namely primary prevention initiation. 10 patients had functional assessment following the CTCA result. 13 patients underwent invasive coronary angiography (ICA) following CTCA. 5/13 had percutaneous coronary intervention and 1/13 patients was referred for CABG. Higher QRISK score was associated with increased number of vessel stenosis (p<0.01) and a higher degree of coronary artery stenosis on CTCA (p<0.01) (figure 1). Conclusions Outpatient CTCA imaging in the stable chest pain cohort can lead to significant changes in patient management. In 34/99 cases primary prevention was optimised and in 44 patients the CTCA demonstrated no coronary disease/plaque leading to discharge from the Cardiology services hence demonstrating its utility as a rule-out test for epicardial obstructive coronary artery disease in a low-risk population. Conflict of Interest None