Inpatient Cardiac CT

Recommended Use of INPATIENT Cardiac/Coronary CTA

Coronary CTA Strengths for Inpatient Use

  • > 95% sensitivity and > 95% negative predictive value for stenotic CAD
  • Simultaneous visualizes other chest structures
  • At Hillcrest Medical Center can be combined with contrast chest CT to look for pulmonary embolism (“triple rule-out”, currently not available at other Hillcrest Hospitals)
  • Less radiation than nuclear myocardial perfusion imaging (advantageous for young patients)
  • Fasting is not needed

Optimal patient characteristics*

  • Resting sinus heart rate < 100 beats per minute at Hillcrest Medical Center or < 80 beats per minute at Hillcrest Hospital South and Bailey Medical Center
  • Able to safely take metoprolol
  • Able to hold breath for 10 seconds at Hillcrest Medical Center, or 15 seconds at Hillcrest Hospital South and Bailey Medical Center
  • Body mass index (BMI) < 40 kg/m2
  • No stent or single proximal stent at least 3 mm in diameter, and no coronary artery bypass surgery

Strong Contraindications

  • Severe contrast allergy (anaphylaxis, shock, coma, seizure)
  • Creatinine clearance < 30 ml/min or acute kidney injury
  • More than 10 PVCs/min
  • Cannot follow instructions or cannot hold breath for 10 seconds
  • High suspicion for acute coronary syndrome or symptomatic CAD

Relative Contraindications

  • Heart rate > 100 bpm and cannot take metoprolol at Hillcrest Medical Center, or > 80 bpm and cannot take metoprolol at Hillcrest Hospital South
  • Creatinine clearance 30-45 ml/min (we will use hydration protocol)
  • Iodinated contrast dose within last 24 hours (> 48 hours between doses recommended)
  • Coronary stent(s) < 3mm in diameter
  • Extremely severe coronary calcification
  • Body mass index (BMI) > 55 kg/m2 at Hillcrest Medical Center or > 45 kg/m2 at Hillcrest Hospital South and Bailey Medical Center


Diagnosis of coronary artery disease (CAD) in a patient with symptom(s) that may represent anginal equivalent:

  • Intermediate probability of stenotic CAD or stenotic bypass graft disease in a symptomatic patient


  • Evaluation of CAD as etiology of newly diagnosed cardiomyopathy – in place of catheterization

Coronary anomaly

  • < 40 years-old and symptoms or prior imaging suggests possible coronary anomaly
  • Coronary anomaly identified on catheterization or other imaging, and more detailed delineation of anomaly anatomy will affect management

Planning interventional/surgical procedures

  • Evaluation for stenotic CAD before valvular or aortic surgery – in place of catheterization
  • Evaluation of bypass graft and chest wall anatomy before redo open heart surgery
  • Left atrial / pulmonary vein evaluation before EP procedures to treat atrial fibrillation
  • Evaluation of left ventricular outflow tract and aorta before transcatheter aortic valve replacement (TAVR)
  • Measurement of left atrial appendage dimensions before appendage occluder device placement
  • Evaluation of mitral valve annulus before transcatheter mitral valve prosthesis implantation

Other cardiac structures, cardiac function, or congenital heart disease

  • Echo and/or MRI produced inconclusive results or are contraindicated