PURPOSE OF REVIEW: Coronary computed tomography angiography (CCTA) is the optimal non-invasive test to rule out coronary artery disease (CAD). Decisions to perform coronary revascularization have traditionally been based upon ischemia testing. This review summarizes the latest observations and trials evaluating the suitability of CCTA to select patients for invasive coronary angiography (ICA) and subsequent revascularization. RECENT FINDINGS: Recent data shows that beyond stenosis, whole-heart quantification and characterization of coronary atherosclerotic plaque improves the estimation of myocardial ischemia. This comprehensive evaluation of the coronary artery tree has greater diagnostic accuracy for invasive fractional flow reserve (FFR) than conventional stress tests. Further, clinical trials have demonstrated that the performance of CCTA in patients with a clinical indication for ICA results in more effective patient care and significantly lower costs. SUMMARY: Besides the excellent ability to rule out CAD, recent data shows that quantification and characterization of the coronary artery tree results in high accuracy for ischemia and that CCTA-guided care to select patients for ICA and revascularization is effective. Trials evaluating revascularization based on CCTA findings may be needed.
PURPOSE OF REVIEW: Coronary computed tomography angiography (CCTA) is the optimal non-invasive test to rule out coronary artery disease (CAD). Decisions to perform coronary revascularization have traditionally been based upon ischemia testing. This review summarizes the latest observations and trials evaluating the suitability of CCTA to select patients for invasive coronary angiography (ICA) and subsequent revascularization. RECENT FINDINGS: Recent data shows that beyond stenosis, whole-heart quantification and characterization of coronary atherosclerotic plaque improves the estimation of myocardial ischemia. This comprehensive evaluation of the coronary artery tree has greater diagnostic accuracy for invasive fractional flow reserve (FFR) than conventional stress tests. Further, clinical trials have demonstrated that the performance of CCTA in patients with a clinical indication for ICA results in more effective patient care and significantly lower costs. SUMMARY: Besides the excellent ability to rule out CAD, recent data shows that quantification and characterization of the coronary artery tree results in high accuracy for ischemia and that CCTA-guided care to select patients for ICA and revascularization is effective. Trials evaluating revascularization based on CCTA findings may be needed.
Authors: P J Scanlon; D P Faxon; A M Audet; B Carabello; G J Dehmer; K A Eagle; R D Legako; D F Leon; J A Murray; S E Nissen; C J Pepine; R M Watson; J L Ritchie; R J Gibbons; M D Cheitlin; T J Gardner; A Garson; R O Russell; T J Ryan; S C Smith Journal: J Am Coll Cardiol Date: 1999-05 Impact factor: 24.094
Authors: Joanne D Schuijf; William Wijns; J Wouter Jukema; Douwe E Atsma; Albert de Roos; Hildo J Lamb; Marcel P M Stokkel; Petra Dibbets-Schneider; Isabel Decramer; Pieter De Bondt; Ernst E van der Wall; Piet K Vanhoenacker; Jeroen J Bax Journal: J Am Coll Cardiol Date: 2006-11-28 Impact factor: 24.094
Authors: Pim A L Tonino; William F Fearon; Bernard De Bruyne; Keith G Oldroyd; Massoud A Leesar; Peter N Ver Lee; Philip A Maccarthy; Marcel Van't Veer; Nico H J Pijls Journal: J Am Coll Cardiol Date: 2010-06-22 Impact factor: 24.094
Authors: Haim Shmilovich; Victor Y Cheng; Balaji K Tamarappoo; Damini Dey; Ryo Nakazato; Heidi Gransar; Louise E J Thomson; Sean W Hayes; John D Friedman; Guido Germano; Piotr J Slomka; Daniel S Berman Journal: Atherosclerosis Date: 2011-08-07 Impact factor: 5.162
Authors: Manesh R Patel; Eric D Peterson; David Dai; J Matthew Brennan; Rita F Redberg; H Vernon Anderson; Ralph G Brindis; Pamela S Douglas Journal: N Engl J Med Date: 2010-03-11 Impact factor: 91.245
Authors: Pim A L Tonino; Bernard De Bruyne; Nico H J Pijls; Uwe Siebert; Fumiaki Ikeno; Marcel van' t Veer; Volker Klauss; Ganesh Manoharan; Thomas Engstrøm; Keith G Oldroyd; Peter N Ver Lee; Philip A MacCarthy; William F Fearon Journal: N Engl J Med Date: 2009-01-15 Impact factor: 91.245
Authors: Bernard De Bruyne; Nico H J Pijls; Bindu Kalesan; Emanuele Barbato; Pim A L Tonino; Zsolt Piroth; Nikola Jagic; Sven Möbius-Winkler; Sven Mobius-Winckler; Gilles Rioufol; Nils Witt; Petr Kala; Philip MacCarthy; Thomas Engström; Keith G Oldroyd; Kreton Mavromatis; Ganesh Manoharan; Peter Verlee; Ole Frobert; Nick Curzen; Jane B Johnson; Peter Jüni; William F Fearon Journal: N Engl J Med Date: 2012-08-27 Impact factor: 91.245
Authors: Leslee J Shaw; Jörg Hausleiter; Stephan Achenbach; Mouaz Al-Mallah; Daniel S Berman; Matthew J Budoff; Fillippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Yong-Jin Kim; Victor Y Cheng; Benjamin J W Chow; Ricardo C Cury; Augustin J Delago; Allison L Dunning; Gudrun M Feuchtner; Martin Hadamitzky; Ronald P Karlsberg; Philipp A Kaufmann; Jonathon Leipsic; Fay Y Lin; Kavitha M Chinnaiyan; Erica Maffei; Gilbert L Raff; Todd C Villines; Troy Labounty; Millie J Gomez; James K Min Journal: J Am Coll Cardiol Date: 2012-10-17 Impact factor: 24.094
Authors: Matthew J Budoff; David Dowe; James G Jollis; Michael Gitter; John Sutherland; Edward Halamert; Markus Scherer; Raye Bellinger; Arthur Martin; Robert Benton; Augustin Delago; James K Min Journal: J Am Coll Cardiol Date: 2008-11-18 Impact factor: 24.094