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Prior to Coronary CT, Beta-Blockers and Nitroglycerin Given

February 29, 2008
Written by: , Filed in: Cardiac Imaging
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The objective of a recent study was to ascertain the patient preparation algorithms used for 64-MDCT CTA of the coronary arteries performed in the United States.

The study has concluded that prior to coronary CT angiography (CTA), all sites administer beta-blockers, usually to achieve a target heart rate <=65 bpm, and most sites also administer nitroglycerin. Methodology
Sites where coronary CTAs were potentially being performed were identified through companies that sell 64-MDCT scanners; two companies agreed to participate and one company declined.

The identified sites were mailed a survey that asked about site experience level, target heart rate and maximum heart rate allowed, protocol for beta-blocker administration, use of calcium channel blockers or other medications, use of nitroglycerin, policy regarding scanning patients with arrhythmias, and physician specialty.

Low experience level was <100 studies performed, moderate experience level was 100 to 500 studies performed, and high experience level was >500 studies performed, or 25 to 50 studies performed per week and >=6 months of experience.

Cardiac CTA: What You Need to Know
 
 University of California San Francisco, Department of Radiology
 Course Director: Gautham P. Reddy, MD, MPH

 
  Coronary artery disease is the leading cause of morbidity and mortality in industrialized countries. With the advent of 64-detector CT scanners, CT has become an essential tool for evaluation of the heart and great vessels, and is a promising technique for assessment of the coronary arteries.
 
  Click here to read more or order:
  Cardiac CTA: What You Need to Know

Results of the Study
563 sites were identified and had surveys mailed to them; 142 surveys were returned and evaluated. Among the sites, 49% had studies performed and interpreted by radiologists, 14% by cardiologists, and the rest shared. In addition, 44% of sites had a low experience level, 41% had a moderate experience level, and 16% had a high experience level.

Among the high experience level sites, 55% were cardiology sites and 30% of the high experience level sites were radiology sites; 89% of sites aimed for a heart rate of <=65 bpm. The maximum heart rate allowed ranged from 59 bpm to no cut off level. Beta-blockers were used by 100% of sites. The most common regimen of beta-blockade employed was oral medication supplemented as needed with IV medication (53%); 36% of sites only used oral beta-blockers and 12% of sites only used IV beta-blockers. Cardiologists more often supplemented oral medication with IV medication. Of the sites that gave oral beta-blockers, 68% gave the medication the day of the CT and 32% gave the first dose the day or night before the scheduled CT. Cardiologists and sites with high experience level more often began beta-blocker premedication on the day or night before the CT examination. Also, 27% of sites reported variably using calcium channel blockers to lower heart rate, and 84% of sites gave nitroglycerin prior to scanning. Regarding scanning patients with arrhythmias, the responses were variable and several sites detailed specific arrhythmias felt to be not contraindicated. Conclusions
Prior to coronary CTA, beta-blockers are routinely given and most sites also administer nitroglycerin. Most sites try to achieve a target heart rate of <=65 bpm. Reviewer’s Comments
The authors have demonstrated some interesting differences between practice regimens of cardiologists and radiologists regarding protocol for beta-blocker administration.

Author: Vineet R. Jain, MD

Reference
Johnson PT, Eng J, et al. 64-MDCT Angiography of the Coronary Arteries: Nationwide Survey of Patient Preparation Practice. AJR; 2008; 190 (March): 743-747:

Cardiac CTA: What You Need to Know
 
 University of California San Francisco, Department of Radiology
 Course Director: Gautham P. Reddy, MD, MPH

 
  Coronary artery disease is the leading cause of morbidity and mortality in industrialized countries. With the advent of 64-detector CT scanners, CT has become an essential tool for evaluation of the heart and great vessels, and is a promising technique for assessment of the coronary arteries.
 
  Click here to read more or order:
  Cardiac CTA: What You Need to Know
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