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{{Chronic stable angina}}
{{Chronic stable angina}}
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editor-in-Chief:''' Smita Kohli, M.D.
'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-in-Chief:''' {{CZ}}; Smita Kohli, M.D.; [[Lakshmi Gopalakrishnan]], M.B.B.S.


==Ultrafast Computed Tomography = Electron Beam Tomography (EBT, EBCT)==
==Overview==
The extent of coronary artery calcification directly correlates to the area of atheromatous plaque <ref name="pmid7554196">Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7554196 Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study.] ''Circulation'' 92 (8):2157-62. PMID: [http://pubmed.gov/7554196 7554196]</ref>. Hence in patients with [[chest pain]], '''coronary artery calcium (CAC) scoring''' is one of the factor to be considered in the risk assessment for [[coronary artery disease]]. The methods used for detection and quantification of CAC are electron beam computed tomography (EBCT) and multi-detector computed tomography (MDCT) <ref name="pmid17239724">Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, Grundy SM et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17239724 ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography.] ''J Am Coll Cardiol'' 49 (3):378-402. [http://dx.doi.org/10.1016/j.jacc.2006.10.001 DOI:10.1016/j.jacc.2006.10.001] PMID: [http://pubmed.gov/17239724 17239724]</ref>. '''Agatston score''' is a computed software that is mostly commonly used to measure CAC based on the density and area of calcified plaques <ref name="pmid2407762">Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2407762 Quantification of coronary artery calcium using ultrafast computed tomography.] ''J Am Coll Cardiol'' 15 (4):827-32. PMID: [http://pubmed.gov/2407762 2407762]</ref>.
 
==Ultrafast Computed Tomography or Electron beam Computed Tomography==


*Ultrafast computed tomography can be used to '''detect coronary calcifications''', which often precede symptomatic coronary artery stenosis. However, coronary calcification is also observed in patients without important [[coronary artery disease]] at angiography.  
*Ultrafast computed tomography can be used to '''detect coronary calcifications''', which often precede symptomatic coronary artery stenosis. However, coronary calcification is also observed in patients without important [[coronary artery disease]] at angiography.  
*CT angiography used for the detection of [[CAD]], has a '''negative predictive value of 93-99%''', sensitivity of 90-94% and specificity of 95-97% <ref name="pmid15840624">Leschka S, Alkadhi H, Plass A, Desbiolles L, Grünenfelder J, Marincek B et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15840624 Accuracy of MSCT coronary angiography with 64-slice technology: first experience.] ''Eur Heart J'' 26 (15):1482-7. [http://dx.doi.org/10.1093/eurheartj/ehi261 DOI:10.1093/eurheartj/ehi261] PMID: [http://pubmed.gov/15840624 15840624]</ref> <ref name="pmid16053973">Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16053973 Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography.] ''J Am Coll Cardiol'' 46 (3):552-7. [http://dx.doi.org/10.1016/j.jacc.2005.05.056 DOI:10.1016/j.jacc.2005.05.056] PMID: [http://pubmed.gov/16053973 16053973]</ref>.
*CT angiography is '''indicated''' in patients with a low pretest probability of [[CAD]] (less than 10%) or in patients with non conclusive exercise ECG or stress test.


*Although this test has generated substantial interest and publicity, its cist and the current lack of information from large scale assessments make it premature to recommend its use in routine clinical care.
*Although this test has generated substantial interest and publicity, its cist and the current lack of information from large scale assessments make it premature to recommend its use in routine clinical care.
Line 18: Line 25:
'''1.''' Patients with a low pre-test probability of disease, with a non-conclusive [[Chronic stable angina exercise electrocardiography|exercise ECG]] or [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|stress imaging]] test. ''(Level of Evidence: C)''}}
'''1.''' Patients with a low pre-test probability of disease, with a non-conclusive [[Chronic stable angina exercise electrocardiography|exercise ECG]] or [[Chronic stable angina perfusion scintigraphy with pharmacologic stress|stress imaging]] test. ''(Level of Evidence: C)''}}


==See Also==
==Vote on and Suggest Revisions to the Current Guidelines==
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]


==Sources==
==Sources==
*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 }} </ref>
*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= |url=url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref>


*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref>
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref>


*TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref>
*TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref>


*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.187930 DOI:10.1161/CIRCULATIONAHA.107.187930] PMID: [http://pubmed.gov/17998462 17998462]</ref>
*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>


==References==
==References==
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[[Category: Cardiology]]
[[Category: Cardiology]]
[[Category: Emergency medicine]]
[[Category: Emergency medicine]]
[[Category: Mature chapter]]


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Revision as of 04:25, 16 August 2011

Chronic stable angina Microchapters

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Differentiating Chronic Stable Angina from Acute Coronary Syndromes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Phone:617-632-7753; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [4]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

The extent of coronary artery calcification directly correlates to the area of atheromatous plaque [1]. Hence in patients with chest pain, coronary artery calcium (CAC) scoring is one of the factor to be considered in the risk assessment for coronary artery disease. The methods used for detection and quantification of CAC are electron beam computed tomography (EBCT) and multi-detector computed tomography (MDCT) [2]. Agatston score is a computed software that is mostly commonly used to measure CAC based on the density and area of calcified plaques [3].

Ultrafast Computed Tomography or Electron beam Computed Tomography

  • Ultrafast computed tomography can be used to detect coronary calcifications, which often precede symptomatic coronary artery stenosis. However, coronary calcification is also observed in patients without important coronary artery disease at angiography.
  • CT angiography used for the detection of CAD, has a negative predictive value of 93-99%, sensitivity of 90-94% and specificity of 95-97% [4] [5].
  • CT angiography is indicated in patients with a low pretest probability of CAD (less than 10%) or in patients with non conclusive exercise ECG or stress test.
  • Although this test has generated substantial interest and publicity, its cist and the current lack of information from large scale assessments make it premature to recommend its use in routine clinical care.

ACC / AHA Guidelines- Electron Beam Tomography (DO NOT EDIT)[6]

“

Class IIb

1. Electron beam computed tomography. (Level of Evidence:B)

”

ESC Guidelines- Computed tomography in patients with chronic stable angina (DO NOT EDIT)[7]

“

Class IIb

1. Patients with a low pre-test probability of disease, with a non-conclusive exercise ECG or stress imaging test. (Level of Evidence: C)

”

Vote on and Suggest Revisions to the Current Guidelines

Sources

  • Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [7]
  • The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [6]
  • TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [8]
  • The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [9]

References

  1. ↑ Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation 92 (8):2157-62. PMID: 7554196
  2. ↑ Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, Grundy SM et al. (2007) ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 49 (3):378-402. DOI:10.1016/j.jacc.2006.10.001 PMID: 17239724
  3. ↑ Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15 (4):827-32. PMID: 2407762
  4. ↑ Leschka S, Alkadhi H, Plass A, Desbiolles L, Grünenfelder J, Marincek B et al. (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26 (15):1482-7. DOI:10.1093/eurheartj/ehi261 PMID: 15840624
  5. ↑ Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46 (3):552-7. DOI:10.1016/j.jacc.2005.05.056 PMID: 16053973
  6. ↑ 6.0 6.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. PMID: 10351980
  7. ↑ 7.0 7.1 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.
  8. ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[1] PMID: 12515758
  9. ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[2] PMID: 17998462


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