Computed tomographic angiography or conventional coronary angiography in therapeutic decision-making

Piers, Lieuwe H.; Dikkers, Riksta; Willems, Tineke P.; Smet, Bart J. G. L. de; Oudkerk, Matthijs; Zijlstra, Felix; Tio, René A.

doi:10.1093/eurheartj/ehn454

Cited by 28 publications

(23 citation statements)

References 19 publications

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“…None of the other covariates showed significant influence. Four studies were most influential on the summary estimates 51,58,60,62 ; however, on the basis of the standardized residuals graph (figure was not shown) studies 13 versus 22 51,58 and 23 versus 24 60,62 compensate the effect of each other on summary parameters estimation. Therefore, by refitting the model and leaving out these studies, pooled sensitivity and pooled specificity changed slightly.…”

Section: Per-patient Analysismentioning

confidence: 96%

“…The estimated mean effective dose ranged from 4.6 to 16 mSv with retrospectively ECG-gated scans 39,40,[45][46][47]49,[51][52][53]58 and 0.9 to 2.65 mSv with prospectively ECG-triggered scans. 41,44,48,55,[57][58][59] All studies used ECG-based tube current modulation for radiation dose reduction, although the length of cardiac cycle through which it was applied and the percentage reduction varied between studies.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Dual-source computed tomography angiography for diagnosis and assessment of coronary artery disease: Systematic review and meta-analysis

Salavati

Radmanesh

Heidari

et al. 2012

Journal of Cardiovascular Computed Tomography

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Section: Per-patient Analysismentioning

confidence: 96%

Section: Characteristics Of Studiesmentioning

confidence: 99%

Dual-source computed tomography angiography for diagnosis and assessment of coronary artery disease: Systematic review and meta-analysis

Salavati

Radmanesh

Heidari

et al. 2012

Journal of Cardiovascular Computed Tomography

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“…Along with these multicenter trials, several studies were published comparing newer generations of CT scanner with catheterization (Table 2) (6,(45)(46)(47)(48)(49)(50).…”

Section: Coronary Artery Disease (Cad): Diagnosismentioning

confidence: 99%

The Year in Cardiac Imaging

Gibbons¹,

Araoz²,

Williamson³

2010

Journal of the American College of Cardiology

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“…In a patientbased analysis, the sensitivity for detecting patients with significant CAD was 85-99%, specificity was 64-90%, positive predictive value was 86-91%, and negative predictive value was 83-97% [13,14]. In a segment-based analysis, the sensitivity was 62-88%, specificity was 79-90%, positive predictive value was 36-47%, and negative predictive value was 95-99% [13,15]. Also the anatomic assessment of the hemodynamic significance of coronary stenoses determined by visual CTCA does not correlate well with the functional assessment of intracoronary fractional flow reserve (FFR) [16,17].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic pathway of integrated SPECT/CT for coronary artery disease

Slart

Tio

Zijlstra

et al. 2009

Eur J Nucl Med Mol Imaging

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Treatment strategy in patients with suspected coronary artery disease (CAD) is driven by symptomatology in combination with diagnostic evaluation of the extent and/or severity of atherosclerosis in the coronary arteries and ischemia in the myocardium, i.e., the anatomic and functional correlates of CAD. Whereas multislice row computed tomography (MSCT) has the advantage of detecting coronary atherosclerosis at its earliest stages, thereby allowing initiation of appropriate therapeutic measures well before development of obstructive CAD, myocardial perfusion imaging (MPI) SPECT can clarify the hemodynamic consequences of the anatomic findings on MSCT based on a functional assessment of myocardial blood flow. There is a lack of correlation between coronary artery calcium (CAC), coronary artery stenosis, and MPI SPECT. Therefore CAC scoring and stress MPI should be thus considered complementary approaches rather than exclusionary in the evaluation of the patient at risk for CAD. The integration of anatomic and functional information may provide additional information for the clinician by the improved risk stratification and diagnostic accuracy of integrated techniques. The majority of previous studies are based on a sequential flowchart, starting with either SPECT or CAC scoring that finally directs the therapeutic strategy. Patients at low risk for CAD can be selected for primary prevention, and patients at high risk for CAD can be directly selected for coronary angiography (CAG). The remaining group of patients at intermediate risk for CAD can be substratified into lower-and higher-risk categories based on the presence or absence of stress-induced ischemia on MPI SPECT and CAC scoring. An integration of SPECT and CAC as a starting point for CAD detection in symptomatic patients at intermediate risk for CAD may facilitate a tailored diagnostic as well as therapeutic approach. Finally, using SPECT/CT, MPI SPECT, and CAC findings may be completed with CT angiography. The development of SPECT/ CT hybrid systems is therefore of important value for the nuclear cardiology armamentarium. This editorial commentary outlines a diagnostic pathway of integrated SPECT/CT for CAD assessment in symptomatic patients at intermediate risk for CAD.

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Computed tomographic angiography or conventional coronary angiography in therapeutic decision-making

Abstract: Although imaging qualities have improved considerably, CT angiography cannot be used for definitive therapeutic decision-making with regard to revascularization procedures in patients with suspected CAD.

Cited by 28 publications

References 19 publications

Dual-source computed tomography angiography for diagnosis and assessment of coronary artery disease: Systematic review and meta-analysis

Dual-source computed tomography angiography for diagnosis and assessment of coronary artery disease: Systematic review and meta-analysis

The Year in Cardiac Imaging

Diagnostic pathway of integrated SPECT/CT for coronary artery disease

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