What are the findings of the Computed Tomography (CT) coronary angiogram?

From the Guidelines

A CT coronary angiogram is a reasonable diagnostic test to perform in patients with suspected coronary artery disease, particularly those with intermediate risk or atypical chest pain, as it provides high-quality images of the coronary arteries and can detect blockages, narrowing, or other abnormalities with a high sensitivity and specificity of 90% to 95% or greater for occlusive CAD 1.

Key Findings of a CT Coronary Angiogram

• The test uses computed tomography technology combined with contrast dye to visualize the coronary arteries.
• It can detect coronary artery disease by showing calcified and non-calcified plaque buildup, stenosis (narrowing), and complete occlusions 1.
• The scan typically reveals the anatomy of the coronary arteries, including the left main, left anterior descending, left circumflex, and right coronary arteries, as well as their branches.
• CT coronary angiograms are particularly useful for patients with intermediate risk of coronary artery disease, atypical chest pain, or inconclusive stress test results 1.

Advantages and Limitations of CT Coronary Angiogram

• Advantages: good to excellent resolution (approximately 0.6 mm) of coronary artery anatomy, short study time (single breath hold), and high negative predictive value 1.
• Limitations: radiation dose (8 to 24 mSv), contrast dye exposure, and necessity to achieve a slow, regular heart rate (beta blockers are usually required) 1.

Clinical Application

• CT coronary angiography has been judged to be useful for evaluation of obstructive CAD in symptomatic patients (Class IIa, Level of Evidence: B) 1.
• It may be particularly appropriate for those with acute chest pain syndromes with intermediate pretest probability of CAD in the setting of nondiagnostic ECG and negative cardiac biomarkers 1.

From the Research

CT Coronary Angiogram Results

The CT coronary angiogram is a diagnostic tool used to visualize the coronary arteries and detect any potential blockages or abnormalities.

• The results of a CT coronary angiogram can help identify individuals with nonobstructive coronary artery disease (CAD), which is associated with a higher risk of mortality 2.
• Studies have shown that statin therapy can reduce the risk of mortality in individuals with nonobstructive CAD 2.
• Aspirin therapy has also been shown to be effective in reducing the risk of coronary heart disease (CHD) events in men, particularly those with a high 10-year risk for CHD 3.
• The use of dual antiplatelet therapy (DAPT) with clopidogrel and aspirin has been shown to be effective in reducing the risk of major adverse cardiovascular and cerebrovascular events in patients undergoing coronary artery bypass grafting 4.

Treatment Implications

The results of a CT coronary angiogram can have significant implications for treatment.

• For individuals with nonobstructive CAD, statin therapy may be recommended to reduce the risk of mortality 2.
• Aspirin therapy may also be recommended for individuals with a high risk of CHD events 3.
• DAPT with clopidogrel and aspirin may be recommended for patients undergoing coronary artery bypass grafting 4.
• The use of antiplatelet agents and anticoagulants, such as aspirin and heparin, can help reduce the risk of thrombosis and cardiovascular events in patients with arteriosclerosis 5.

Risk Factors and Considerations

When interpreting the results of a CT coronary angiogram, it is essential to consider the individual's risk factors and medical history.

• The presence and extent of nonobstructive CAD can predict mortality 2.
• The use of aspirin and statin therapy can have significant benefits in reducing the risk of CHD events, but may also be associated with increased risks of bleeding and other adverse events 5, 3.
• The cost-effectiveness of different treatment strategies, including the use of aspirin, statins, and DAPT, should be carefully considered 3.