Coronary CT angiography is a well-established diagnostic modality for stable angina pectoris. It provides an angiographic, non-invasive alternative for the diagnosis of coronary artery disease, exceeding in the ability to exclude important coronary artery disease. Having the ability t

Dedic, A. (Admir)

Dedic, Admir

EUR Research Repository

504299-L-st-DedicProcessed on: 6-9-2016Propositions accompanying the thesis:Coronary CT in Acute Cardiac Care1. Coronary CT angiography outperforms calcium imaging in the triage of patients suspected of having an acute coronary syndrome (this thesis).2. Coronary CT angiography applied early in the work-up of a suspected acute coronary syndrome is safe and associated with less out-patient testing and lower costs (this thesis).3. It is important to keep in mind that the optimal imaging strategy is determined not only by the diagnostic performance of a modality but also by local practice, expertise with imaging techniques, medical facilities, and individual patient characteristics (this thesis).4. Coronary CT angiography findings are a strong predictor of future adverse events, showing incremental value over clinical predictors, stress testing, and coronary calcium scores (this thesis).5. Patients with chest pain but no coronary calcifications have an excellent prognosis, and these patients may not require further imaging with coronary CT angiography (this thesis). 6. The clinician must understand that the prediction of risk of a subsequent malignancy for an individual undergoing a medical diagnostic test, or procedure, employing ionizing radiation is a complex, uncertain exercise (Laskey, JACC: Cardiovascular Imaging, 2010: 517-24).7. The use of nonrandomized observational studies is an important tool for determining the effectiveness of a therapy in routine clinical practice (Nallamothu, Circulation, 2008: 1294-303).8. On an abstract level, consumers are interested in policy changes that will reduce medical spending. However, when consumers are individually affected, price does not play a role (Heinemann, Health Policy, 2013: 113-21).9. Opponents argue that competition is not appropriate for health care provision as the ‘logic of care’ conflicts with the ‘logic of competition’ (Maarse, Health Economics, Policy and Law, 2016: 161-78). 10. In the Netherlands, progressive migrant health policies – and broader policies of multiculturalism – have been undermined or even reversed by political parties reliant on anti-immigration sentiments (Rechel, Lancet, 2013: 1235-45).11. The scientists of today think deeply instead of clearly. One must be sane to think clearly, but one can think deeply and be quite insane (Nikola Tesla).Admir Dedić5 October 2016

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Coronary CT in Acute Cardiac Care

Coronary CT angiography is a well-established diagnostic modality for stable angina pectoris. It provides an angiographic, non-invasive alternative for the diagnosis of coronary artery disease, exceeding in the ability to exclude important coronary artery disease. Having the ability to reliably exclude coronary artery disease might be of particular benefit to patients who present at the emergency department with suspected coronary artery disease. Although the majority of them have a benign cause for their complaints, missing an acute coronary syndrome can have grave consequences. In the first part, we investigated the value of coronary CT angiography in patients presenting to the emergency department suspected of an acute coronary syndrome. The findings on a coronary CT angiogram might not only be useful for diagnostic purposes, they also may serve as markers of future cardiac adverse events. It seems likely that the presence and degree of coronary artery disease detected by coronary CT angiography will also provide information regarding cardiac adverse events in the future. In the second part, we investigate the prognostic value of coronary CT angiography in different patient population

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Coronary CT in Acute Cardiac Care

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