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Coronary Computed Tomography Angiography as a Gatekeeper to Coronary Revascularization: Emphasizing Atherosclerosis

Inge J van den Hoogen1,2, Alexander R van Rosendael1, Fay Y Lin1

  • 1Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.

Current Cardiovascular Imaging Reports
|June 21, 2019
PubMed

Insights

Coronary computed tomography angiography (CCTA) effectively rules out coronary artery disease (CAD). Advanced CCTA plaque analysis accurately identifies ischemia, guiding patient selection for invasive coronary angiography (ICA) and revascularization, improving care and reducing costs.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Diagnostic Accuracy

Background:

  • Coronary artery disease (CAD) diagnosis traditionally relies on ischemia testing for revascularization decisions.
  • Coronary computed tomography angiography (CCTA) is a leading non-invasive tool for ruling out CAD.

Purpose of the Study:

  • To review current evidence on CCTA's role in selecting patients for invasive coronary angiography (ICA).
  • To evaluate CCTA's suitability for guiding revascularization decisions.

Main Methods:

  • Review of recent observations and clinical trials.
  • Analysis of CCTA's ability to quantify and characterize coronary atherosclerotic plaque.
  • Comparison of CCTA diagnostic accuracy with conventional stress tests and invasive fractional flow reserve (FFR).

Main Results:

  • Whole-heart plaque quantification and characterization by CCTA improve myocardial ischemia estimation.
  • CCTA demonstrates higher diagnostic accuracy for ischemia compared to stress tests.
  • CCTA-guided patient selection for ICA leads to more effective care and lower costs.

Conclusions:

  • CCTA excels at ruling out CAD and accurately assessing ischemia through plaque analysis.
  • CCTA-guided selection for ICA and revascularization is effective and cost-efficient.
  • Further trials investigating CCTA-based revascularization decisions are warranted.
Abstract

Keywords:
AtherosclerosisCoronary artery diseaseCoronary computed tomography angiographyCoronary revascularization

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