Editorial Comment
Management of patients after computed tomography coronary angiography: Evidence and room for improvement
Tratamento de doentes após angiocoronariografia computorizada: evidência e espaço para aperfeiçoamento
Nuno Bettencourt
Faculdade de Medicina, Universidade do Porto, Porto, Portugal
Read
2858
Timeswas read the article
1455
Total PDF
1403
Total HTML
Share statistics
array:24 [ "pii" => "S2174204919300133" "issn" => "21742049" "doi" => "10.1016/j.repce.2019.02.006" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1336" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2019;38:51-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 425 "formatos" => array:3 [ "EPUB" => 83 "HTML" => 182 "PDF" => 160 ] ] "Traduccion" => array:1 [ "en" => array:20 [ "pii" => "S0870255117307345" "issn" => "08702551" "doi" => "10.1016/j.repc.2018.05.014" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1330" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2019;38:45-50" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1299 "formatos" => array:3 [ "EPUB" => 98 "HTML" => 752 "PDF" => 449 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Additional cardiac investigation prior to the introduction of the CAD-RADS classification in coronary computed tomography angiography reports" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "45" "paginaFinal" => "50" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Investigação cardíaca adicional antes da introdução da classificação CAD-RADS® nos relatórios de AngioTC coronária" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1206 "Ancho" => 2500 "Tamanyo" => 167112 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients according to CAD-RADS classification. ICA: invasive coronary angiography; LM: left main.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sara Guerreiro, António Miguel Ferreira, João Abecasis, Carla Saraiva, Hélder Dores, Gonçalo Cardoso, Ana Coutinho Santos, Mariana Castro, Miguel Mendes" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Sara" "apellidos" => "Guerreiro" ] 1 => array:2 [ "nombre" => "António Miguel" "apellidos" => "Ferreira" ] 2 => array:2 [ "nombre" => "João" "apellidos" => "Abecasis" ] 3 => array:2 [ "nombre" => "Carla" "apellidos" => "Saraiva" ] 4 => array:2 [ "nombre" => "Hélder" "apellidos" => "Dores" ] 5 => array:2 [ "nombre" => "Gonçalo" "apellidos" => "Cardoso" ] 6 => array:2 [ "nombre" => "Ana Coutinho" "apellidos" => "Santos" ] 7 => array:2 [ "nombre" => "Mariana" "apellidos" => "Castro" ] 8 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204919300133" "doi" => "10.1016/j.repce.2019.02.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919300133?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117307345?idApp=UINPBA00004E" "url" => "/08702551/0000003800000001/v5_201911281009/S0870255117307345/v5_201911281009/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2174204919300017" "issn" => "21742049" "doi" => "10.1016/j.repce.2019.01.001" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1263" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Rev Port Cardiol. 2019;38:53-63" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 898 "formatos" => array:3 [ "EPUB" => 95 "HTML" => 490 "PDF" => 313 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review Article</span>" "titulo" => "New approach to diabetes care: From blood glucose to cardiovascular disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "53" "paginaFinal" => "63" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Nova abordagem para o tratamento da diabetes: da glicemia à doença cardiovascular" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1522 "Ancho" => 2919 "Tamanyo" => 289400 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Factors contributing to raised cardiovascular risk in type 2 diabetes (adapted from Libby and Plutzky<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">62</span></a>). CRP: C-reactive protein; FFA: free fatty acids; HDL: high-density lipoprotein; LDL: low-density lipoprotein; PAI-1: plasminogen activator inhibitor-1; TG: triglycerides; TNF-α: tumor necrosis factor alpha; VLDL: very low-density lipoprotein.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Aguiar, Rui Duarte, Davide Carvalho" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Aguiar" ] 1 => array:2 [ "nombre" => "Rui" "apellidos" => "Duarte" ] 2 => array:2 [ "nombre" => "Davide" "apellidos" => "Carvalho" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255118300994" "doi" => "10.1016/j.repc.2018.03.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255118300994?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919300017?idApp=UINPBA00004E" "url" => "/21742049/0000003800000001/v2_201911290936/S2174204919300017/v2_201911290936/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2174204919300121" "issn" => "21742049" "doi" => "10.1016/j.repce.2019.02.005" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "1330" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2019;38:45-50" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 552 "formatos" => array:3 [ "EPUB" => 89 "HTML" => 265 "PDF" => 198 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Additional cardiac investigation prior to the introduction of the CAD-RADS classification in coronary computed tomography angiography reports" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "45" "paginaFinal" => "50" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Investigação cardíaca adicional antes da introdução da classificação CAD-RADS® nos relatórios de AngioTC coronária" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1206 "Ancho" => 2500 "Tamanyo" => 167112 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients according to CAD-RADS classification. ICA: invasive coronary angiography; LM: left main.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sara Guerreiro, António Miguel Ferreira, João Abecasis, Carla Saraiva, Hélder Dores, Gonçalo Cardoso, Ana Coutinho Santos, Mariana Castro, Miguel Mendes" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Sara" "apellidos" => "Guerreiro" ] 1 => array:2 [ "nombre" => "António Miguel" "apellidos" => "Ferreira" ] 2 => array:2 [ "nombre" => "João" "apellidos" => "Abecasis" ] 3 => array:2 [ "nombre" => "Carla" "apellidos" => "Saraiva" ] 4 => array:2 [ "nombre" => "Hélder" "apellidos" => "Dores" ] 5 => array:2 [ "nombre" => "Gonçalo" "apellidos" => "Cardoso" ] 6 => array:2 [ "nombre" => "Ana Coutinho" "apellidos" => "Santos" ] 7 => array:2 [ "nombre" => "Mariana" "apellidos" => "Castro" ] 8 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919300121?idApp=UINPBA00004E" "url" => "/21742049/0000003800000001/v2_201911290936/S2174204919300121/v2_201911290936/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial Comment</span>" "titulo" => "Management of patients after computed tomography coronary angiography: Evidence and room for improvement" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "51" "paginaFinal" => "52" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Nuno Bettencourt" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Nuno" "apellidos" => "Bettencourt" "email" => array:1 [ 0 => "bettencourt.n@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Faculdade de Medicina, Universidade do Porto, Porto, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tratamento de doentes após angiocoronariografia computorizada: evidência e espaço para aperfeiçoamento" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years coronary computed tomography angiography (CCTA) has become the unquestionable gold standard for non-invasive coronary anatomy assessment. Its role in the management of patients with chest pain is gaining importance in the clinical arena and the tendency in recent guidelines is to prefer CCTA as first-line testing over other imaging modalities.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However, CCTA is a purely anatomical test and one of the main criticisms that have been made of its widespread use is that it may increase unnecessary referrals for cardiac catheterization, another anatomical test. Furthermore, the lack of a unified reporting system may limit the clinical impact of the test on subsequent management.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In order to improve patient management after CCTA, a standardized reporting system has recently been introduced.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The Coronary Artery Disease - Reporting and Data System (CAD-RADS) classification parallels similar successes in other areas of medicine, notably the BI-RADS classification for breast exams, and provides recommendations for further management, according to the test result. Patients with no coronary artery disease or no significant stenosis (>50%) detected on CCTA should be excluded from further testing, while those with detected stenosis should proceed to ischemia assessment or viability testing and/or invasive coronary angiography (ICA), if appropriate.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> One of the main advantages of this approach is its emphasis on the need for functional testing before ICA when intermediate and/or severe stenosis is detected on CCTA, in order to reduce false positive referrals and the ‘oculo-stenotic reflex’ in the catheterization laboratory.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, an interesting paper by Guerreiro et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> describes the post-test management of 200 patients referred for CCTA due to suspected or known coronary artery disease in a Portuguese tertiary center prior to the introduction of the CAD-RADS classification in CCTA reports, comparing post-test management with that proposed under the new system. Interestingly, but not unexpectedly, the results show that in patients with CAD-RADS classifications at the ends of the spectrum, additional cardiac investigation after CCTA was almost always in agreement with the recommendations, but in patients with intermediate scores, ICA prevailed over functional testing. This result reinforces the general perception that too many patients are being directly referred for catheterization after CCTA, and are therefore being excluded from the benefits of functional testing (which could potentially improve subsequent treatment). Even in patients with more severe stenosis (>70%) – in whom direct referral for catheterization may be considered under the CAD-RADS classification (and were therefore considered in agreement with the CAD-RADS recommendations in this paper) – these real-world data reveal the clear preponderance of anatomically-driven paths in patient management after CCTA (with non-invasive testing performed in only 10% of these cases). It is clear that, as the authors state, not all of these patients were excluded from functional testing, since some may have been tested invasively using fractional flow reserve or instantaneous wave-free ratio measurement. Nevertheless, the under-use of non-invasive functional tests in this population demonstrates that there is room for improvement and should prompt reflection concerning the causes and actions required. As Guerreiro et al. noted, easy access to ICA compared to stress imaging tests may explain a significant part of this referral bias. Therefore, in order to fully benefit from the unprecedented information provided by advanced imaging modalities like CCTA, cardiology departments as we know them must change. For the sake of better patient management, promotion of timely and accurate non-invasive diagnostic approaches (reserving ICA mostly for therapeutic procedures) is essential. Cath-lab-centered departments should give way to balanced and structured units in which multimodality non-invasive and invasive techniques are equally available. Only then can we look forward to the full positive impact on both efficacy and costs of these techniques and the additional value of systematic classification systems like CAD-RADS in clinical practice.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin (update). CG95" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "National Institute for Health and Clinical Excellence" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2016" "editorial" => "National Institute for Health and Clinical Excellence" "editorialLocalizacion" => "London" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary Artery Disease – Reporting and Data System (CAD-RADS): an expert consensus document of SCCT, ACR and NASCI: endorsed by the ACC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.C. Cury" 1 => "S. Abbara" 2 => "S. Achenbach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcmg.2016.05.005" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Imaging" "fecha" => "2016" "volumen" => "9" "paginaInicial" => "1099" "paginaFinal" => "1113" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27609151" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comment on “CAD-RADSTM Coronary Artery Disease – Reporting and Data System: an expert consensus document of SCCT, ACR and NASCI: endorsed by the ACC”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N. Bettencourt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "557" "paginaFinal" => "558" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Additional cardiac investigation prior to the introduction of the CAD-RADS classification in coronary computed tomography angiography reports" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Guerreiro" 1 => "A.M. Ferreira" 2 => "J. Abecasis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2018.05.014" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2019" "volumen" => "38" "paginaInicial" => "45" "paginaFinal" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30661933" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003800000001/v2_201911290936/S2174204919300133/v2_201911290936/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003800000001/v2_201911290936/S2174204919300133/v2_201911290936/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919300133?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 3 | 13 |
| 2024 October | 36 | 24 | 60 |
| 2024 September | 34 | 22 | 56 |
| 2024 August | 34 | 24 | 58 |
| 2024 July | 28 | 27 | 55 |
| 2024 June | 25 | 33 | 58 |
| 2024 May | 29 | 22 | 51 |
| 2024 April | 27 | 24 | 51 |
| 2024 March | 24 | 29 | 53 |
| 2024 February | 20 | 21 | 41 |
| 2024 January | 26 | 30 | 56 |
| 2023 December | 19 | 24 | 43 |
| 2023 November | 36 | 43 | 79 |
| 2023 October | 11 | 18 | 29 |
| 2023 September | 18 | 21 | 39 |
| 2023 August | 20 | 15 | 35 |
| 2023 July | 18 | 10 | 28 |
| 2023 June | 21 | 8 | 29 |
| 2023 May | 27 | 24 | 51 |
| 2023 April | 17 | 6 | 23 |
| 2023 March | 18 | 19 | 37 |
| 2023 February | 23 | 17 | 40 |
| 2023 January | 12 | 18 | 30 |
| 2022 December | 22 | 17 | 39 |
| 2022 November | 31 | 25 | 56 |
| 2022 October | 22 | 26 | 48 |
| 2022 September | 27 | 32 | 59 |
| 2022 August | 16 | 24 | 40 |
| 2022 July | 23 | 39 | 62 |
| 2022 June | 22 | 29 | 51 |
| 2022 May | 19 | 28 | 47 |
| 2022 April | 20 | 24 | 44 |
| 2022 March | 31 | 46 | 77 |
| 2022 February | 26 | 35 | 61 |
| 2022 January | 16 | 16 | 32 |
| 2021 December | 18 | 36 | 54 |
| 2021 November | 20 | 32 | 52 |
| 2021 October | 30 | 46 | 76 |
| 2021 September | 16 | 29 | 45 |
| 2021 August | 26 | 30 | 56 |
| 2021 July | 17 | 17 | 34 |
| 2021 June | 19 | 21 | 40 |
| 2021 May | 27 | 33 | 60 |
| 2021 April | 37 | 34 | 71 |
| 2021 March | 21 | 23 | 44 |
| 2021 February | 22 | 15 | 37 |
| 2021 January | 20 | 15 | 35 |
| 2020 December | 19 | 18 | 37 |
| 2020 November | 15 | 18 | 33 |
| 2020 October | 12 | 14 | 26 |
| 2020 September | 10 | 9 | 19 |
| 2020 August | 11 | 17 | 28 |
| 2020 July | 15 | 16 | 31 |
| 2020 June | 11 | 18 | 29 |
| 2020 May | 7 | 10 | 17 |
| 2020 April | 16 | 6 | 22 |
| 2020 March | 15 | 12 | 27 |
| 2020 February | 38 | 19 | 57 |
| 2020 January | 10 | 7 | 17 |
| 2019 December | 15 | 7 | 22 |
| 2019 November | 10 | 9 | 19 |
| 2019 October | 11 | 5 | 16 |
| 2019 September | 8 | 9 | 17 |
| 2019 August | 12 | 9 | 21 |
| 2019 July | 11 | 10 | 21 |
| 2019 June | 16 | 24 | 40 |
| 2019 May | 14 | 13 | 27 |
| 2019 April | 16 | 18 | 34 |
| 2019 March | 28 | 30 | 58 |
| 2019 February | 2 | 3 | 5 |
Show all
