The Present State of Coronary CT Angiography
In the past 5 years since the introduction of 64-detector row cardiac computed tomography angiography (CCTA), there has been an exponential growth in the quantity of scientific evidence to support the feasibility of its use in the clinical evaluation of individuals with suspected coronary artery disease (CAD). Since then, there has been considerable debate as to where CCTA precisely fits in the algorithm of evaluation of individuals with suspected CAD. Proponents of CCTA contend that the quality and scope of the available evidence to date support the replacement of conventional methods of CAD evaluation by CCTA, whereas critics assert that clinical use of CCTA is not yet adequately proven and should be restricted, if used at all. Coincident with the scientific debate underlying the clinical utility of CCTA, there has developed a perception by many that the rate of growth in cardiac imaging is disproportionately high and unsustainable. In this respect, all noninvasive imaging modalities and, in particular, more newly introduced ones, have undergone a higher level of scrutiny for demonstration of clinical and economic effectiveness. We herein describe the latest available published evidence supporting the potential clinical and cost efficiency of CCTA, drawing attention not only to the significance but also the limitations of such studies. These points may trigger discussion as to what future studies will be both necessary and feasible for determining the exact role of CCTA in the workup of patients with suspected CAD.
Cardiac computed tomography angiography (CCTA) has emerged in recent years as a promising noninvasive anatomic imaging modality for coronary artery and cardiac structural and functional evaluation. Developments in computed tomography (CT) technology, driven principally by improvements in temporal resolution, spatial resolution, and volume coverage, now permit routine evaluation of the coronary arteries and cardiovascular structures with clarity. CCTA has experienced resultant rapid clinical adoption by some for assessment of patients with suspected coronary artery disease (CAD). This year, scientific guidelines for performance, interpretation, and reporting of CCTA were published that can aid the clinician-imager in the proper execution of CCTA. Nevertheless, despite the rapid growth in the scientific evidence base that has supported the formation of these guidelines, numerous evidence gaps continue to exist in this still nascent field, thus precluding the development of practice guidelines that can endorse the proper clinical application of CCTA.
The purpose of this review is to highlight contemporary developments that have occurred in the field of CCTA that may help to bridge certain evidence gaps. We focus our discussion on issues related to diagnostic accuracy, prognostic risk stratification, cost-effectiveness, and safety.
Abstract and Introduction
Abstract
In the past 5 years since the introduction of 64-detector row cardiac computed tomography angiography (CCTA), there has been an exponential growth in the quantity of scientific evidence to support the feasibility of its use in the clinical evaluation of individuals with suspected coronary artery disease (CAD). Since then, there has been considerable debate as to where CCTA precisely fits in the algorithm of evaluation of individuals with suspected CAD. Proponents of CCTA contend that the quality and scope of the available evidence to date support the replacement of conventional methods of CAD evaluation by CCTA, whereas critics assert that clinical use of CCTA is not yet adequately proven and should be restricted, if used at all. Coincident with the scientific debate underlying the clinical utility of CCTA, there has developed a perception by many that the rate of growth in cardiac imaging is disproportionately high and unsustainable. In this respect, all noninvasive imaging modalities and, in particular, more newly introduced ones, have undergone a higher level of scrutiny for demonstration of clinical and economic effectiveness. We herein describe the latest available published evidence supporting the potential clinical and cost efficiency of CCTA, drawing attention not only to the significance but also the limitations of such studies. These points may trigger discussion as to what future studies will be both necessary and feasible for determining the exact role of CCTA in the workup of patients with suspected CAD.
Introduction
Cardiac computed tomography angiography (CCTA) has emerged in recent years as a promising noninvasive anatomic imaging modality for coronary artery and cardiac structural and functional evaluation. Developments in computed tomography (CT) technology, driven principally by improvements in temporal resolution, spatial resolution, and volume coverage, now permit routine evaluation of the coronary arteries and cardiovascular structures with clarity. CCTA has experienced resultant rapid clinical adoption by some for assessment of patients with suspected coronary artery disease (CAD). This year, scientific guidelines for performance, interpretation, and reporting of CCTA were published that can aid the clinician-imager in the proper execution of CCTA. Nevertheless, despite the rapid growth in the scientific evidence base that has supported the formation of these guidelines, numerous evidence gaps continue to exist in this still nascent field, thus precluding the development of practice guidelines that can endorse the proper clinical application of CCTA.
The purpose of this review is to highlight contemporary developments that have occurred in the field of CCTA that may help to bridge certain evidence gaps. We focus our discussion on issues related to diagnostic accuracy, prognostic risk stratification, cost-effectiveness, and safety.
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