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Outcomes of anatomical vs. functional testing for coronary artery disease : Lessons from the major trials

Júlia Karády1,2, Jana Taron3,4, Andreas Anselm Kammerlander3,5

  • 1Cardiovascular Imaging Research Center, Massachusetts General Hospital-Harvard Medical School, 165 Cambridge St Suite 400, 02114, Boston, MA, USA. jkarady@mgh.harvard.edu.

Herz
|June 7, 2020
PubMed

Insights

Coronary CT angiography, particularly with fractional flow reserve, shows high accuracy for stable coronary artery disease (CAD). This advanced imaging is emerging as a preferred first-line tool over traditional functional testing for diagnosing obstructive CAD.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Testing

Background:

  • Estimating pretest probability for obstructive coronary artery disease (CAD) and identifying patients who benefit from revascularization remain challenging.
  • Functional testing shows modest agreement with invasive angiography and is less effective in low-prevalence obstructive CAD settings.
  • Coronary computed tomography (CT) angiography offers excellent diagnostic accuracy and prognostic value, especially when combined with noninvasive fractional flow reserve (FFR) testing.

Purpose of the Study:

  • To provide an overview of the evidence supporting coronary CT angiography in stable CAD evaluation.
  • To discuss the clinical implications and limitations of current data on coronary CT angiography.
  • To identify areas for future research regarding the role of coronary CT angiography in patient management.

Main Methods:

  • Review of existing evidence on coronary CT angiography and fractional flow reserve (FFR) in stable CAD.
  • Analysis of landmark trials such as PROMISE and SCOT-HEART.
  • Consideration of European Society of Cardiology 2019 Guidelines recommendations.

Main Results:

  • Coronary CT angiography, especially with FFR, demonstrates high diagnostic accuracy and prognostic value.
  • Evidence challenges the primary role of functional testing in patients without known CAD.
  • Landmark trials support the efficient management and improved outcomes with coronary CT angiography.

Conclusions:

  • Coronary CT angiography is an emerging first-line tool for evaluating stable chest pain, as recommended by 2019 ESC guidelines.
  • Further research is needed to address limitations and remaining questions regarding its optimal use.
  • Coronary CT angiography offers a more efficient approach to managing suspected stable CAD compared to traditional methods.

Keywords:
Computed tomographyCoronary angiographyFunctional stress testingInvasive coronary angiographyTreatment outcome

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