CT Coronary Angiography

Cardiology Associates are excited to be involved in a collaboration with Sutherland Heart Clinic and Southern Radiology to bring CT Coronary Angiography to patients in the Sutherland Shire.

CT Coronary Angiography is a technique which has evolved rapidly over the past decade. From the early days of quantifying calcium in the coronary circulation (a technique which has now been validated as an independent predictor of adverse cardiac outcomes) we can now demonstrate with high accuracy coronary artery anatomy and atheroma when compared to conventional invasive coronary angiography.

The role of this technique is evolving and expanding in Australia and internationally. We firmly believe that CT Coronary Angiography has an important role to play in management of our patients with ischaemic heart disease. In those patients that have typical symptoms of myocardial ischaemia with abnormal investigations such as ECG or cardiac enzymes, CT Coronary Angiography is not warranted. These patients should have conventional angiography and revascularisation as appropriate. In the large group of intermediate risk patients that may be asymptomatic but are in a “grey zone” with regards to the need for medical therapy and aggressive risk factor control, CT Coronary Angiography may clarify the direction of further management. Patients that may be intermediate or high risk with chest pain syndromes and negative physiological tests may benefit from CT Coronary Angiography rather than necessarily proceeding to invasive assessment. Patients at very low risk with atypical symptoms (especially young patients who have an increased lifetime risk of developing adverse effects of radiation exposure) will generally not require CT Coronary assessment. Patients in atrial fibrillation and those with significant renal impairment should also have alternative assessment. Extensive calcification in coronary arteries can limit the accuracy of this technique as can the presence of coronary stents.

A 64 slice multi detector CT scanner in the Southern Radiology Offices in Urunga Parade, Miranda is used for cardiac assessment. Patients are given oral Metoprolol 50 to 100mg prior to their test. Approximately 100mls of IV contrast is administered. Patients remain in the radiology rooms for 1 ½ to 2 hours. Radiation dosages are generally low (5 to 10 mSV) which is marginally more than a conventional coronary angiogram but less than a Nuclear Perfusion Scan. Reporting of the scans is currently performed by Radiologists at Southern Radiology.

CT Coronary Angiography is reimbursed by Medicare in Australia (from July 2011)under the following conditions;
1.Centres use a 64 slice or greater scanner.
2.Requested by Cardiologist or consultant physician.
3. Stable symptoms consistent with ischaemic heart disease at low to intermediate risk that would otherwise be considered for cardiac catheter
4.To eclude anomalous coronary anatomy or coronary fistulas.
5. To evaluate coronary anatomy in patients undergoing non coronary cardiac surgery.
Otherwise the fee for this procedure is about $600.00.

We would all be happy to discuss this technique and its application in your patients at any time.