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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
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Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease
Carlos Collet1,2, Yoshinobu Onuma3,4, Daniele Andreini5
1Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, the Netherlands.
European Heart Journal
|October 13, 2018
Summary
Coronary computed tomography angiography (CTA) shows high agreement with conventional angiography for complex coronary artery disease treatment decisions. This non-invasive imaging may guide revascularization strategies, improving patient care.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Coronary computed tomography angiography (CTA) is a non-invasive method for diagnosing coronary artery disease.
- Its utility in complex coronary artery disease (CAD) requires further investigation.
Purpose of the Study:
- To assess agreement between heart teams on treatment decisions using coronary CTA versus conventional angiography.
- To evaluate the impact of fractional flow reserve derived from CTA (FFRCT) on treatment planning.
Main Methods:
- Heart teams (interventional cardiologist, cardiac surgeon, radiologist) evaluated patients with de novo left main or three-vessel CAD.
- Teams used either coronary CTA or conventional angiography, blinded to the other modality.
- Treatment recommendations (CABG, PCI, or equipoise) were based on SYNTAX Score II, predicting 4-year mortality.
Main Results:
- High agreement was observed between heart teams using coronary CTA and conventional angiography for treatment decisions (Cohen's kappa = 0.82).
- Teams agreed on revascularization segments in 80% of cases.
- FFRCT influenced treatment decisions in 7% of patients.
Conclusions:
- Coronary CTA-based treatment decisions demonstrate high concordance with conventional angiography in complex CAD.
- Coronary CTA holds potential as a sole imaging modality for treatment decision-making and planning in conjunction with clinical information.
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