From the Guidelines
Coronary Computed Tomography Angiography (CTCA) should be performed to diagnose and assess the presence and severity of coronary artery disease in patients with chronic chest pain and a high probability of coronary artery disease, as it has been shown to have high diagnostic accuracy and can lead to improved patient outcomes. The procedure can diagnose the presence of atherosclerotic plaque, the degree of coronary artery stenosis, coronary artery dissection, or congenital anomalies of coronary arteries 1. CTCA has a reported high accuracy compared with invasive coronary angiography (ICA) and high negative predictive value (NPV) 1. The CCTA ACCURACY trial found 95% sensitivity, 83% specificity, 64% positive predictive value (PPV), and 99% NPV for detection of coronary artery disease, suggesting that CTCA possesses high diagnostic accuracy for detecting coronary stenosis at thresholds of 50% 1. Some of the key benefits of CTCA include:
- High diagnostic accuracy for detecting coronary stenosis
- Ability to detect both calcified and non-calcified plaques in the arteries
- Less invasive than traditional coronary angiography
- Can help rule out significant coronary artery disease in patients with low to intermediate risk, potentially avoiding unnecessary invasive procedures
- Can lead to improved patient outcomes, including a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years compared with standard of care alone 1. However, CTCA does involve radiation exposure and the use of contrast material, so it's not recommended for routine screening in asymptomatic individuals 1. The decision to perform CTCA should be based on individual patient factors and clinical judgment, taking into account the patient's symptoms, medical history, and risk factors for coronary artery disease.
From the Research
Reasons to Perform Coronary Computed Tomography Angiography (CTCA)
- To evaluate patients with suspected coronary artery disease, as it shows high accuracy compared with invasive coronary angiography and high negative predictive value 2
- As a first-line test for the evaluation of stable chest pain, due to its ability to provide effective gatekeeping to cardiac catheterization, selective discrimination for revascularization and tailored medical therapy, advanced risk stratification, improvement in outcomes, and support from multisociety guidelines 2
- To diagnose coronary artery disease (CAD) with precision, identify high-risk patients for cardiac events, and provide significantly greater diagnostic certainty for proper treatment, including referral for invasive coronary angiography with revascularization 3
- To define the presence, absence, and severity of coronary artery disease, particularly in those patients who are categorized to be at intermediate risk by conventional risk factor assessment for a cardiovascular event 4
- To fulfill a gatekeeper role to invasive angiography in higher-risk populations, identify non-obstructive coronary disease and alternative diagnoses, and provide accurate assessment of stenosis severity, characterization of high-risk plaque, and findings associated with perivascular inflammation 5
Benefits of CTCA
- High negative predictive value, making it a useful tool for ruling out coronary artery disease 2, 5
- Ability to provide a comprehensive evaluation of a patient's coronary anatomy and per-vessel ischemic evaluation 3
- Reduction in unnecessary downstream testing and cost savings due to its high diagnostic accuracy and prognostic data 3
- Lower radiation exposure to clinicians compared to conventional coronary angiography 4
- Safe practice guidelines are available to ensure good quality scans and outcomes in a safe environment 6