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Dec 17, 2024 | Clinical Edition

Calcium Scores & Coronary Clues: Unmasking Cardiac Risks in Anesthesia

 

 

Check out the timestamps below to help you navigate through the many topics we discussed.

On This Episode:

Dive into the cutting-edge world of perioperative care this week with Terry and Garry. Join us as we unravel the mysteries of coronary imaging and its transformative role in anesthesia practice.

From the reassuring power of a zero coronary calcium score to the intricate plaque details revealed by coronary CT angiography, this episode offers a deep dive into tools that are reshaping cardiac risk assessment and management. Whether you're a seasoned clinician or simply curious about the latest advancements, this discussion promises to be both engaging and enlightening.

Here’s some of what we discuss in this episode:

  • The role of coronary CT in preoperative workups.
  • Understanding coronary CTA, how it differs from calcium scoring, and why nurse anesthetists should care.
  • When not to use these modalities.
  • Translating these findings into actionable decisions for our anesthesia plan.
  • Where do you see coronary CT technology heading in the next decade?

 

Donate to Our Heart Your Hands here: https://www.ourheartsyourhands.org/donate 

The 1099 CRNA Institute: https://aana.com/1099

 

"The future of coronary imaging holds so much promise from AI-driven diagnostics to seamless integration with electronic health records."

- Garry & Terry

References

  1. Budoff, M. J., Achenbach, S., Blumenthal, R. S., Carr, J. J., Goldin, J. G., Greenland, P., … & Shaw, L. J. (2006). Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation, 114(16), 1761–1791.
  2. Bos, D., & Leening, M. J. G. (2018). Leveraging the coronary calcium scan beyond the coronary calcium score. European Radiology, 28(7), 3082–3087. https://doi.org/10.1007/s00330-017-5264-3
  3. Cardoso, R., Nasir, K., Blumenthal, R. S., & Blaha, M. J. (2019). Selective use of coronary artery calcium testing for shared decision making: guideline endorsed and ready for prime time. Annals of Internal Medicine, 170(4), 262–263.
  4. Douglas, P. S., Hoffmann, U., Patel, M. R., Mark, D. B., Al-Khalidi, H. R., Cavanaugh, B., … & Khan, M. A. (2015). Outcomes of anatomical versus functional testing for coronary artery disease. New England Journal of Medicine, 372(14), 1291–1300.
  5. Doris, M., & Newby, D. E. (2016). Coronary CT angiography as a diagnostic and prognostic tool: perspectives from the SCOT-HEART trial. Current Cardiology Reports, 18(2), 18.
  6. Foy, A. J., Dhruva, S. S., Peterson, B., et al. (2017). Coronary computed tomography angiography vs functional stress testing for patients with suspected coronary artery disease: a systematic review and meta-analysis. JAMA Internal Medicine, 177(11), 1623–1631.
  7. Ghekiere, O., Salgado, R., Buls, N., Leiner, T., Mancini, I., Vanhoenacker, P., … & Nchimi, A. (2017). Image quality in coronary CT angiography: challenges and technical solutions. The British Journal of Radiology, 90(1072), 20160567.
  8. Hecht, H. S., Cronin, P., Blaha, M. J., Budoff, M. J., Kazerooni, E. A., Narula, J., Yankelevitz, D., & Abbara, S. (2017). 2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology. Journal of Cardiovascular Computed Tomography, 11(1), 74–84. https://doi.org/10.1016/j.jcct.2016.11.003
  9. Jorgenson, M. E., Andersson, C., Norgaard, B. L., et al. (2017). Functional testing or coronary computed tomography angiography in patients with stable coronary artery disease. Journal of the American College of Cardiology, 69(14), 1761–1770.
  10. Kruk, M., Noll, D., Achenbach, S., Mintz, G. S., Pręgowski, J., Kaczmarska, E., … & Witkowski, A. (2014). Impact of coronary artery calcium characteristics on accuracy of CT angiography. JACC: Cardiovascular Imaging, 7(1), 49–58.
  11. Liu, W., et al. (2015). Current understanding of coronary artery calcification. Journal of Geriatric Cardiology: JGC, 12(6), 668.
  12. Miller, T. D., & Rodriguez-Porcel, M. (2016). Your Coronary Calcium Scan Is Positive: Now What? JACC: Cardiovascular Imaging, 9(5), 590–592. https://doi.org/10.1016/j.jcmg.2015.12.012
  13. Mitchell, J. D., Fergestrom, N., Gage, B. F., Paisley, R., Moon, P., Novak, E., … & Villines, T. C. (2018). Impact of statins on cardiovascular outcomes following coronary artery calcium scoring. Journal of the American College of Cardiology, 72(25), 3233–3242.
  14. Modarressi, T. (2020). Risks and Costs of Routine Preventive Coronary Artery Calcium Scans. The American Journal of Medicine, 133(9), e535–e535. https://doi.org/10.1016/j.amjmed.2020.02.027
  15. Moreno, P. R. (2009). The high-risk thin-cap fibroatheroma: a new kid on the block. Circulation: Cardiovascular Interventions, 2, 500–502.
  16. Nasir, K. (2018). Message for 2018 Cholesterol Management Guidelines Update: Time to Accept the Power of Zero. Journal of the American College of Cardiology, 72(25), 3243.
  17. Ostrom, M. P., Gopal, A., Ahmadi, N., Nasir, K., Yang, E., Kakadiaris, I., … & Budoff, M. J. (2008). Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography. Journal of the American College of Cardiology, 52(16), 1335–1343.
  18. SCOT-HEART Investigators. (2018). Coronary CT angiography and 5-year risk of myocardial infarction. New England Journal of Medicine, 379(10), 924–933.
  19. Valenti, V., ó Hartaigh, B., Heo, R., Cho, I., Schulman-Marcus, J., Gransar, H., … & Sandesara, P. (2015). A 15-year warranty period for asymptomatic individuals without coronary artery calcium: a prospective follow-up of 9,715 individuals. JACC: Cardiovascular Imaging, 8(8), 900–909.
  20. Various Online Resources:
  • https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Guidelines/2018/Guidelines-Made-Simple-Tool-2018-Cholesterol.pdf
  • https://www.ahajournals.org/doi/pdf/10.1161/CIR.0b013e3181fcae66
  • https://www.forbes.com/sites/harlankrumholz/2015/10/05/this-test-might-tell-you-if-you-dont-need-a-statin/#39617ede242d
  • https://www.nice.org.uk/guidance/cg95/evidence/full-guideline-245282221

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