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Coronary computed tomographic angiography as gatekeeper for new-onset stable angina

C K M Boerhout1, R G T Feenstra1, G A Somsen2

  • 1Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|October 22, 2021
PubMed

Insights

Coronary computed tomographic angiography (CCTA) should be prioritized for diagnosing new-onset stable angina. This approach offers better diagnostic yield and cost-effectiveness, guiding treatment decisions for obstructive coronary artery disease.

Area of Science:

  • Cardiology
  • Diagnostic Imaging

Background:

  • New-onset stable angina is common in cardiology practice.
  • Current diagnostic strategies rely on pre-test probability for obstructive coronary artery disease.
  • Guideline-directed workup involves functional or anatomical testing, with no clear noninvasive preference above 5% pre-test probability.

Purpose of the Study:

  • To advocate for a greater role of coronary computed tomographic angiography (CCTA) in diagnosing new-onset stable angina.
  • To highlight CCTA's diagnostic yield and cost-effectiveness.

Main Methods:

  • Review of diagnostic workup for stable angina.
  • Consideration of cost-effectiveness analysis from the PROMISE trial.
  • Evaluation of diagnostic yield in patients with angina and nonobstructive coronary artery disease.

Main Results:

  • Coronary computed tomographic angiography (CCTA) demonstrates significant diagnostic yield.
  • CCTA is cost-effective, particularly in patients with nonobstructive coronary artery disease.
  • Current guidelines lack a clear preference for noninvasive testing in specific patient groups.

Conclusions:

  • Coronary computed tomographic angiography (CCTA) should be considered a primary gatekeeper test for new-onset stable angina.
  • CCTA offers a superior diagnostic pathway compared to current noninvasive testing options.
  • This approach can optimize patient management and resource utilization.

Keywords:
Chronic coronary syndromesCoronary artery diseaseCoronary computed tomographic angiographyGatekeeperNonobstructive coronary artery disease

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