Integrated coronary computed tomographic angiography in an office-based cardiology practice.

Multidetector coronary computed tomographic angiography (CCTA) visualizes coronary artery disease directly, thereby identifying atherosclerosis rather than ischemia. CCTA has the potential to be a useful, noninvasive gatekeeper for the identification of patients who are appropriate candidates for conventional coronary angiography and can also help determine the need for more aggressive risk modification, including cholesterol control. Integration of 64-slice CCTA scanning into a large, urban cardiology practice resulted in clearer stratification of patients into those with and without disease. Physicians used this information to improve lipid management while simultaneously reducing the use of other cardiac testing. The ability to assess cardiac calcium scoring was an additional advantage of integrating CCTA into the practice. Further reductions in the use of myocardial perfusion imaging may be expected as a result of the use of CCTA as the first test for the intermediate-risk patient.