Principal Investigator Discusses New Coronary CT Angiography Research at UCSF

The following was written by Karen G. Ordovas, M.D., an Assistant Professor in Residence in the Department of Radiology at UCSF.

In a recent blog, I reported that two current studies support the belief that coronary CT angiography (coronary CTA) is as good or better than the current clinical standard practice performed to exclude coronary disease in the emergency room. The most recent study, “CT Angiography for Safe Discharge of Patients with Possible Acute Coronary Syndromes,” was published in the April 12 issue of the New England Journal of Medicine.

That study solidly underscored the safety of coronary CTA in the emergency room.  The primary concern of the study’s investigators pertained to the safety of the coronary CTA approach; the concern was that patients would be discharged from the emergency room after receiving a coronary CTA and then would end up having a heart attack.

The study used the following logic to define safety:  If a patient was discharged with negative results from a coronary CTA and did not develop a heart attack or unstable angina within 30 days, they were deemed safe.  The most important finding from the study was that of all 640 patients with a normal CT who were discharged, not one had a major cardiac event after 30 days.

On June 30, we were fortunate to have the study’s principal investigator, Harold I. Litt, MD, PhD, address a combined Radiology, Cardiology and Emergency Medicine Grand Rounds at UCSF.  Now an Associate Professor of Radiology and Chief of the Cardiovascular Imaging Section, Radiology, at the Hospital of the University of Pennsylvania, Dr. Litt received some of his advanced training at UCSF during academic year 2001-2002, when he was a clinical fellow in cardiothoracic imaging.

Dr. Litt’s visit gave us the opportunity to discuss the feasibility of the coronary CTA approach and the details of the protocol, including the resources involved in the procedure. We were able to learn more about the protocol by having colleagues who are involved in the three main specialties (Emergency Medicine, Cardiology, and Radiology) present during the discussions, and their participation provided us an opportunity to address the protocol from a multidisciplinary perspective.  Dr. Litt’s visit was enlightening because it enabled us to examine the main concerns about this particular approach, as well as to discuss the operational details associated with it.

UCSF has a protocol in place for performing coronary CTA that is very similar to the one that was used in the study.  Dr. Litt’s visit reinforced our opinion that UCSF is moving in the right direction, that coronary CTA is a viable option, and that we already have a system in place to make it work.

On top of the study by Dr. Litt and his colleagues, the results of another trial are expected to be published very soon.  ROMICAT II (“Rule Out Myocardial Ischemia/Infarction Using Computer Assisted Tomography”) is a large clinical trial that is similar to “CT Angiography for Safe Discharge of Patients with Possible Acute Coronary Syndromes,” and it could provide additional support for UCSF’s coronary CTA protocol.

Look for continuing information about coronary CTA, a very exciting advance in the fight against coronary artery disease.

To read more on cardiac and pulmonary imaging, please see these blogs here.