Periprocedural Safety of 64-detector Row Coronary Computed Tomographic Angiography: Results from the Prospective Multicenter ACCURACY Trial

Background: Coronary computed tomographic angiography (CCTA) requires iodinated contrast and often atrioventricular nodal blocking agents and nitroglycerin for heart rate lowering and coronary vasodilation, respectively. To date, the periprocedural safety of CCTA is unknown.

Objectives: The purpose of this study was to evaluate the periprocedural safety of CCTA.

Methods: We prospectively evaluated 232 patients with symptomatic chest pain without preexisting renal insufficiency at 16 sites who underwent CCTA as part of the Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography (ACCURACY) trial. Patients received iodinated contrast, β-blockers, and nitroglycerin as part of a predefined CCTA protocol. We assessed the rates of adverse events (AEs) related to these agents.

Results: As measured by serum creatinine and creatinine clearance, no significant change was observed in renal function from baseline (1.00 ± 0.19 mg/dL; modification of diet in renal disease [MDRD]: 76.91 ± 17.96 mL/min/1.73 m(2)) to 48 hours (1.0 ± 0.2 mg/dL; P = 1.00; MDRD change: 0.2 ± 12.4 mL/min/1.73 m(2); P = 0.83) or at 30 days (1.0 ± 0.2 mg/dL; P = 0.52; MDRD change: -0.9 ± 16.9 mL/min/1.73 m(2); P = 0.77). Mean systolic blood pressure decreased from baseline (133 ± 19 mm Hg) at 1 hour (125 ± 17 mm Hg; P < 0.001) and rebounded at 48 hours (133 ± 17 mm Hg). Mean heart rate decreased from baseline (65 ± 10 beats/min) at 1 hour (60 ± 7 beats/min) but rose at 48 hours (69 ± 11 beats/min; P < 0.001. All patients were asymptomatic from baseline to follow-up.

Conclusions: The performance of CCTA is safe with low rates of AEs.