New cardiac CT-scanner at Peconic Bay Medical Center can quickly detect deadly blockages, saving lives

New technology deployed at Peconic Bay Medical Center this summer allows doctors to look at a patient’s coronary arteries without using any invasive procedures.

Thanks to PBMC’s ultra-fast cardiac CT-scanner, not only can cardiologists assess a patient’s coronary arteries for blockages without snaking a catheter into the arteries, they can obtain important details about the nature of any blockages and assess blood flow through the heart muscle — details that they previously could not acquire through traditional catheter probes.

“Advances over the over the last few years have been significant — to the point where it’s replacing the traditional nuclear stress testing, exercise stress testing that we’ve previously done,” said Dr. Andrew Persits, director of the cardiac catheterization lab at Peconic Bay Medical Center.

“The CT-scan previously only gave us anatomic information,” Persits said. “It would say you have plaque buildup in your arteries, you do not have plaque buildup in your arteries… and the degree of narrowing.”

But it didn’t tell doctors anything about the characteristics of the plaque buildup — whether it’s soft and fibrous and unstable plaque or a hardened, calcified older, mature plaque, Persists said. And that’s important information for a doctor assessing the threat to a patient.

“Recent advances have been in physiology, meaning is there is there a change in blood flow before and after a blockage,” Persits said. Being able to assess change in blood flow enables doctors to determine if a blockage is significant and should be treated.

With the latest technology available in Riverhead as of June, East End patients no longer need to travel west for this life-saving diagnostics and treatment, he said.

And it’s already saving lives, Persits said.

The hospital did 130 cardiac CT-scans in June and July, he said. “Of those, 25 patients were referred for cardiac cath. Eleven of those patients ended up getting scented and two ended up getting open heart surgery,” Persits said.

Among the patients whose cardiac CT-scans done with PBMC’s new scanner earned a trip to the cardiac cath lab was Natalie Crowe of Setauket.

Crowe, 64, went for her regular annual physical this spring and a routine EKG showed “a very tiny, tiny change.”

The nurse practitioner told her the change was “very small, but it’s here. I don’t think it’s anything much but the machine says that you could have had a heart attack.”

Crowe was incredulous. She’s very active, exercises regularly and had not had any symptoms. “I am not breathless when I walk. I don’t have to stop coming up the stairs halfway through because I am out of breath. I don’t have muscle fatigue. I’ve never had like a tingling in my jaw. I mean, I said nothing.”

She was told to consult a cardiologist. “When I left the office, I almost thought, I don’t really need to go do that,” she said.

Crowe called her husband Artie, an administrator at PBMC. He insisted she see a cardiologist. She called Northwell Health Cardiology and in about a week and a half had an appointment with Dr. Stanley Katz, chairman of cardiology at PBMC.

Katz agreed the change in her EKG was minimal. Normally, he told her, he’d tell her to come back in a month or two for a follow up.

But she also had “mildly high cholesterol” Katz told her. The hospital has a brand-new CT angio that would be online in about two weeks, he said. “I want you to have one at the hospital. Get yourself on the schedule.” He told her if she had no plaques in her arteries, they’d address it with diet. If she had plaques, she might need a stent.

Crowe was an x-ray tech in angiography for eight years before starting a family 30 years ago.

“Back then when we did angiography, we use catheters that were larger and we used the groin as the access point. You know, patients are instructed ‘You’re going to feel a very hot sensation go through your body and in spite of that, don’t move and don’t breathe. It will pass within a minute but just don’t move.’”

This test was nothing like that, Crowe said. It was a simple IV and it took 15, maybe 20 minutes. “It’s just incredible,” she said.

The IV is used to deliver a contrast material that helps your blood vessels show up on the CT-scan, she said. It’s similar to the contrast used when you have a nuclear stress test.

Crowe got the results that same day and they showed she has a narrowing of one cardiac artery — in her LAD.

LAD stands for left anterior descending artery, the largest coronary artery, which supplies a lot of blood to the left side of the heart.

“That’s what they call the widowmaker,” Crowe said.

It’s got that name because an LAD blockage often causes fatal heart attacks.

Crowe’s CT-scan showed her LAD had an 80% soft, non-calcified plaque, Persits said.

“These these are the types of plaques that kill people,” Persits said.

“And the reason is a soft plaque that is made of lots of fat and cholesterol and hasn’t had time to mature and harden and calcify is very apt to rupture,” he said.

“When it ruptures, inflammatory molecules inside that plaque get into the bloodstream, and the body thinks it’s bleeding. The body wants to attack it and it forms a clot there with platelets and that’s how you how you have a heart attack,” Persits said.

“We get really nervous when we start seeing plaques of this character, as opposed to you know, an 85-year-old patient that may have had coronary disease for a long time, may have been a smoker in the past, has high blood pressure, diabetes — they tend to have hardened and more calcified plaque, less prone to rupturing and causing an acute heart attack,” he explained.

“So in Natalie’s case, very soft plaque, very kind of dangerous features very concerning, especially because of its location in the widowmaker,” Persits said.

Since Katz was not available to do a catheterization until about a week later, he referred her to Persits, who was available to do the procedure the next day.

Crowe found the procedure had evolved a lot since she worked in angiography more than 30 years ago.

Dr. Persits goes in through the wrist instead of the groin. “He said I’m going to find out exactly the degree of narrowing you have on this test, which he told her is even more accurate than the CT-scan. If she needed a stent the entire process would take about an hour, he told her. If she didn’t need a stent it would be about a half-hour.

Crowe described the atmosphere in the room where the procedure is done as “very tranquil.” She said she never felt anything. She could actually see the screen and see what was going on as Persits investigated her arteries.

He told Crowe she had an 85% blockage and needed a stent.

The whole procedure took 40 minutes, she said. “I didn’t feel And I didn’t feel a hot sensation. He didn’t even ask me to hold my breath. I felt nothing,” Crowe said.

Recovery was “nothing,” she said. A small pressure bandage was applied to her wrist and she was told not to lift things with her hand for a week. She stayed overnight because she had a stent put in.

“Honestly I don’t even know if I can call it a recovery because really, I felt a little tired. And so for the day afterwards at home I took it easy and rested,” Crowe said. “But then, boy, I felt really really, really good. Within hours of getting home, I felt so much more like myself. I felt strong and you know, like I wasn’t afraid to get up and walk around.”

She was instructed to take it easy and not to lift more than 10 pounds because they don’t want your heart rate to go up. “So they told me not to exert myself,” she said.

“Going through that procedure. It’s so easy and all I could think of when I came out of it was people need to know that this is so easy, they don’t need to be afraid. It was so easy. I couldn’t believe it,” Crowe said.

Not long ago, she said, cardiac catheterization was reserved for people who had a heart attack or some very strong symptoms. “Then and only then did you know the status of your cardiac arteries,” she said.

Persits encourages people to speak to their primary care doctors about whether testing is appropriate for them. “All good medical care starts with the primary care doctor, the quarterback of the healthcare team,” Persits said.

“We don’t mind testing, we don’t mind looking for these things, especially if there’s concern — family history, symptoms. You know, these are these are the conditions we’d like to pick up, as opposed to me waking up at 3 o’clock in the morning and trying to save someone’s life from heart attack. I prefer to identify disease before it becomes a major issue,” he said.

Northwell Health’s commitment to build a cardiac catheterization lab at Peconic Bay Medical Center was a primary factor in the community hospital’s decision to merge with the Northwell Health system in 2015 (when it was still known as North Shore-LIJ.)

Northwell tasked Katz with establishing an interventional cardiology program in Riverhead, the first of its kind on the East End. Under his leadership, the health system had a temporary cardiac cath lab operational at the Riverhead hospital by the fall of 2016. The facility meant cardiac patients on the East End no longer had to travel an hour or more for the lifesaving procedure.

The new $1.5 million CT-scanner, housed in a specially built room that alone cost $750,000 to construct, was funded as part of Peconic Bay Medical Center’s capital project plan for ongoing investments.