ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography

Abstract

The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance (CMR) appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria (1). The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease (CAD) was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography (CT) for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research.

2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology

“…16,27,28 The inclusion of CAC in guidelines is summarized in Table 2. Formal recognition of the power of CAC occurred in 2010, 10 30 Subsequently, the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults assigned a class IIb (may be considered) recommendation to CAC, and recommended its use in patients in whom the Pooled Cohort Equation risk decision was unclear. 4 The 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk stated that CAC was "likely to be the most useful of the current approaches to improving risk assessment among individuals found to be at intermediate risk after formal risk assessment.".…”

Association of Thoracic Aorta Calcium Score With Exercise Blood Pressure Response and Clinical Outcomes in Elderly Individuals: Differential Impact of Aorta Calcification Compared With Coronary Artery Calcification

“…In current practice, the use of noncontrast CT of the chest is rapidly emerging as a screening tool for identifying asymptomatic patients at high risk of CAD, as well as for lung cancer screening 31. Coronary CT angiography is gaining further consideration as a gatekeeper or useful alternative for invasive coronary angiography 32.…”

Determinants of future cardiovascular health in women with a history of preeclampsia

“…[40][41][42] This may be helpful as surrogate endpoints for intervention studies, as well as potentially add to global CVD risk assessment and guide treatment decisions. [43][44][45][46][47] Subclinical atherosclerosis is commonly assessed by carotid intima-media thickness (cIMT), coronary artery calcium score (CACS), coronary computed tomography angiography (CCTA) and cardiac magnetic resonance imaging (CMR). [5,[46][47][48][49][50][51][52][53][54][55][56][57][58] In recent years, some groups have started to evaluate these imaging techniques in former preeclampsia patients, as discussed below.…”

“…In summary, there is growing interest in CACS and possibly low dose CCTA for CVD risk assessment in the general population. [44] CACS seems to be the most promising imaging marker and the AHA guideline now recommends considering CACS if the treatment decision is inconclusive based on global CVD risk assessment. [15] 2.4.3 Cardiac magnetic resonance imaging Cardiac magnetic resonance (CMR) is a non-invasive imaging technique that enables detailed soft tissue characterization and can assess different parameters of cardiovascular function, as well as macrovascular and microvascular features of CVD without using ionizing radiation.…”