Sunce Clinic, Zagreb, Croatia
Title: CCTA in real not-so-developed world
Mladen Jukic, MD, FSCCT, FESC, is practicing cardiologist with more than 10 yrs of experience in invasive cardiology and more than 6 yrs experience in CCTA, which he has introduced in Croatia. He's also board member of Croatian Cardiac Society, and managing director of Sunce Clinics, Croatia, the largest private medical business in Croatia. He has a number of presentations on Croatian and international conferences, as well as scientific publications.
During the War in Croatia, from 1991-1995, the majority of patients with CAD were treated conservatively. Revascularization was performed only rarely for ACS patients. In the “Ere of stentomania, 1995-2005”, which due to the limited resources “flamed” in Croatia in smaller intensity than possibly elsewhere, and before the COURAGE-Ere, I performed over 8000 diagnostical procedures and over 1200 PCI-procedures.
The fundamental clinical problem with CAD is in its unpredictability. For that reason my primary professional interest in the last decade has been focused on its early (non-invasive, and in near future probably genetically-based) detection, where nowadays I believe CCTA can prove very usable. To evaluate how CCTA altered the management of patients with suspected CAD we studied 792 patients.
After CCTA, obstructive CAD was excluded in 666 patients. During 12-month follow-up, 98.6% of these patients were free of major adverse cardiac events. Also, indication for ICA was revoked in 77.2% of patients. It was also revoked in all patients with low pre-test risk, 80.7% with intermediate and 72.6% with high risk. Medical therapy was changed in 54.7% of patients.
Based on our 6-year experience and published evidence-based data, I believe that CCTA can help not only in reliable detection of CAD, but also to choose the most appropriate management for the vast majority of CAD-patients. CCTA also can allow for faster, easier and simpler evaluation, and replace ICA in the majority of patients, together with its complications, but also direct and indirect costs it is coupled with.