scholarly journals Limited diagnostic yield of non-invasive coronary angiography by 16-slice multi-detector spiral computed tomography in routine patients referred for evaluation of coronary artery disease

2005 ◽  
Vol 26 (19) ◽  
pp. 1987-1992 ◽  
Author(s):  
Christoph Kaiser ◽  
Jens Bremerich ◽  
Sabine Haller ◽  
Hans Peter Brunner-La Rocca ◽  
Georg Bongartz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Diagnostic Yield ◽  
Invasive Coronary Angiography ◽  
Spiral Computed Tomography ◽  
Spiral Computed ◽  
Non Invasive ◽  
Artery Disease

Invasive and non-invasive (computed tomography) angiography

ESC CardioMed ◽  
2018 ◽  
pp. 1348-1353
Author(s):  
Stephan Achenbach
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Invasive Coronary Angiography ◽  
Coronary Computed Tomography ◽  
Non Invasive ◽  
Artery Disease

For diagnosis and treatment planning of patients with stable coronary artery disease, coronary angiography is of particular importance. Invasive coronary angiography is a robust and accurate method for the identification of coronary artery stenoses and occlusions, with the option for immediate intervention. Due to its invasiveness, its small, but not negligible risk for complications, and the fact that angiographic stenosis severity does not closely correspond with ischaemia, coronary angiography is not a first-line test in patients with suspected coronary artery disease. Invasive coronary angiography should be performed when non-invasive testing indicates the presence of relevant ischaemia, when symptoms are compelling and cannot be controlled by medication, or when symptoms are accompanied by reduced left ventricular ejection fraction. In order to determine the presence or absence of ischaemia, invasive coronary angiography can be complemented by fractional flow reserve measurements. Coronary computed tomography angiography is a non-invasive alternative method to visualize the coronary lumen, but requires careful patient selection, data acquisition, and processing. It is not as stable and robust as invasive coronary angiography. However, the use of coronary computed tomography angiography can be considered in patients with a low-to-intermediate risk for coronary artery disease in order to rule out coronary artery stenoses when patient characteristics indicate a high likelihood of fully diagnostic image quality.

scholarly journals Diagnostic and prognostic value of coronary artery calcium score of zero: is it time for guidelines to change?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Arbas Redondo ◽  
D Tebar Marquez ◽  
I.D Poveda Pinedo ◽  
R Dalmau Gonzalez-Gallarza ◽  
S.C Valbuena Lopez ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Calcium ◽  
Cardiac Ct ◽  
Invasive Coronary Angiography ◽  
Agatston Score ◽  
Non Invasive ◽  
Artery Disease

Abstract Introduction Cardiac computed tomography (CT) use has progressively increased as the preferred initial test to rule out coronary artery disease (CAD) when clinical likelihood is low. Coronary artery calcium (CAC) detected by CT is a well-established marker for cardiovascular risk. However, it is not recommended for diagnosis of obstructive CAD. Absence of CAC, defined as an Agatston score of zero, has been associated to good prognosis despite underestimation of non-calcified plaques. Purpose To evaluate whether zero CAC score could help ruling out obstructive CAD in a safely manner. Methods Observational study based on a prospective database of patients (pts) referred to cardiac CT between 2017 and 2019. Pts with an Agatston score of zero were selected. Results We included 176 pts with zero CAC score and non-invasive coronary angiography performed. The median duration of follow-up was 23.9 months. Baseline characteristics of the population are shown in Table 1. In 117 pts (66.5%), cardiac CT was indicated as part of their chest pain evaluation. Mean age was 57.2 years old, 68.2% were women and only and 9.4% were active smokers. Normal coronary arteries were found in 173 pts (98.3%). Obstructive CAD, defined as ≥50% luminal diameter stenosis of a major vessel, was present in 1/176 (0.6%); while non-obstructive atherosclerotic plaques were found in 2 pts (1.1%). During follow-up, one patient died of out-of-hospital cardiac arrest. None either suffered from myocardial infarction or needed coronary revascularization. Conclusions In our cohort, a zero CAC score detected by cardiac CT rules out obstructive coronary artery disease in 98.3%, with only 1.7% of non-calcified atherosclerosis plaques and 0.6% of major adverse events. Although further research on this topic is needed, these results support the fact that non-invasive coronary angiography could be avoided in patients with low clinical likelihood of CAD and zero CAC score, facilitating the management of the increasing demand for coronary CT and reduction of radiation dose. Funding Acknowledgement Type of funding source: None

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