scholarly journals 2180Safety and efficacy of coronary computed tomography angiography for guiding the implementation of invasive coronary angiography according to pre-test probability of significant coronary artery disease

2017 ◽  
Vol 38 (suppl_1) ◽  
Author(s):  
D. Han ◽  
J. Szymonifka ◽  
J.H. Lee ◽  
A. Rizvi ◽  
H. Mirhedayati ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Invasive Coronary Angiography ◽  
Significant Coronary Artery Disease ◽  
Artery Disease ◽  
Test Probability

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 Detection of relevant extracardiac findings on coronary computed tomography angiography vs. invasive coronary angiography

2021 ◽  
Author(s):  
Dominik Laskowski ◽  
Sarah Feger ◽  
Maria Bosserdt ◽  
Elke Zimmermann ◽  
Mahmoud Mohamed ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Invasive Coronary Angiography ◽  
Potential Clinical Benefit ◽  
Artery Disease

Abstract Objectives To compare the detection of relevant extracardiac findings (ECFs) on coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA) and evaluate the potential clinical benefit of their detection. Methods This is the prespecified subanalysis of ECFs in patients presenting with a clinical indication for ICA based on atypical angina and suspected coronary artery disease (CAD) included in the prospective single-center randomized controlled Coronary Artery Disease Management (CAD-Man) study. ECFs requiring immediate therapy and/or further workup including additional imaging were defined as clinically relevant. We evaluated the scope of ECFs in 329 patients and analyzed the potential clinical benefit of their detection. Results ECFs were detected in 107 of 329 patients (32.5%; CTA: 101/167, 60.5%; ICA: 6/162, 3.7%; p < .001). Fifty-nine patients had clinically relevant ECFs (17.9%; CTA: 55/167, 32.9%; ICA: 4/162, 2.5%; p < .001). In the CTA group, ECFs potentially explained atypical chest pain in 13 of 101 patients with ECFs (12.9%). After initiation of therapy, chest pain improved in 4 (4.0%) and resolved in 7 patients (6.9%). Follow-up imaging was recommended in 33 (10.0%; CTA: 30/167, 18.0%; ICA: 3/162, 1.9%) and additional clinic consultation in 26 patients (7.9%; CTA: 25/167, 15.0%; ICA: 1/162, 0.6%). Malignancy was newly diagnosed in one patient (0.3%; CTA: 1/167, 0.6%; ICA: 0). Conclusions In this randomized study, CTA but not ICA detected clinically relevant ECFs that may point to possible other causes of chest pain in patients without CAD. Thus, CTA might preclude the need for ICA in those patients. Trial registration NCT Unique ID: 00844220 Key Points • CTA detects ten times more clinically relevant ECFs than ICA. • Actionable clinically relevant ECFs affect patient management and therapy and may thus improve chest pain. • Detection of ECFs explaining chest pain on CTA might preclude the need for performing ICA.

scholarly journals Coronary Computed Tomography Angiography for Assesment of Stable Coronary Artery Disease – a Cost-effectiveness Perspective

2021 ◽  
Vol 6 (1) ◽  
pp. 37-42
Author(s):  
Roxana Hodas ◽  
Ștefania Alexandra Polexa ◽  
Manuca Rareș ◽  
Theodora Benedek
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Chest Pain ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Significant Coronary Artery Disease ◽  
Coronary Computed Tomography ◽  
Artery Disease

Abstract Patients with chest pain presenting to the emergency room are currently investigated using either invasive coronary angiography (ICA) or noninvasive coronary computed tomography angiography (CCTA). ICA remains an expensive diagnostic tool and exposes patients to a high risk of periprocedural complication. Besides the currently available expansive economic evidence, there is still an important lingering issue: to establish, from the healthcare provider’s point of view, which is the most cost-effective investigation tool for the detection of significant coronary artery disease. The aim of this article is to present the latest developments in the field of imaging tools for the detection of coronary atherosclerosis in patients with chest pain, from the perspective of a cost-effectiveness analysis.

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