Coronary Computed Tomographic Angiography for Complete Assessment of Coronary Artery Disease

Serruys, Patrick W.; Hara, Hironori; Garg, Scot; Kawashima, Hideyuki; Nørgaard, Bjarne Linde; Dweck, Marc R; Bax, Jeroen J.; Knuuti, Juhani; Nieman, Koen; Leipsic, Jonathon; Mushtaq, Saima; Andreini, Daniele; Onuma, Yoshinobu

doi:10.1016/j.jacc.2021.06.019

Cited by 94 publications

(55 citation statements)

References 133 publications

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“…Given that the non-invasive approach is potentially effective and safe, it can constitute an alternative to the invasive, hospitalization-dependent, expensive, higher risk, direct ICA strategy. Our findings correspond to the recently published guidelines regarding chronic coronary syndromes and support the need for extended use of coronary CTA [20].…”

Section: Discussionsupporting

confidence: 90%

Efficacy and safety of coronary computed tomography angiography in patients with a high clinical likelihood of obstructive coronary artery disease

et al. 2022

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Background:The CAT-CAD trial showed that coronary computed tomography angiography (CTA) in patients with a high prevalence of coronary artery disease (CAD) and indications for invasive coronary angiography (ICA) reduces the number of patients undergoing ICA by two-thirds and nearly eradicates non-actionable ICAs. However, the long-term benefits of this non-invasive strategy remain unknown. Aims:To evaluate the long-term efficacy and safety of a non-invasive strategy employing coronary CTA vs. ICA as the first-line imaging test in stable patients with a high clinical likelihood of obstructive CAD. Methods:The long-term outcomes were evaluated for 36 months following randomization and included the efficacy outcome (analyzed as the composite of major adverse cardiovascular events (MACE): all-cause death, acute coronary syndrome, unplanned coronary revascularization, urgent hospitalization for a cardiovascular reason, a stroke) and the safety outcome (analyzed as a cumulative incidence of serious adverse events).Results: One hundred and twenty participants at a mean age of 60.6 (7.9) years (female, 35.0%) were randomized with an allocation ratio of 1:1 to coronary CTA and direct ICA as the first-line anatomical test for suspected obstructive CAD. There were no significant differences between both diagnostic strategies neither in terms of the long-term efficacy (MACE occurrence: 15.5% in coronary CTA group vs. 16.7% in ICA group; log-rank P = 0.89) nor the long-term safety (cumulative number of serious adverse events: 36 vs. 38; P = 0.79, respectively). Conclusions:Long-term follow-up of the randomized CAT-CAD trial confirms t hat t he s trategy employing coronary CTA is an effective and safe, non-invasive, outpatient-based alternative to ICA for patients with a high clinical likelihood of obstructive CAD.

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Section: Discussionsupporting

confidence: 90%

Efficacy and safety of coronary computed tomography angiography in patients with a high clinical likelihood of obstructive coronary artery disease

et al. 2022

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“…Coronary computed tomography angiography (CCTA) has become a cost-effective first line technique in the diagnosis of patients with chest pain ( 1 , 2 ). The diagnostic performance of CCTA varies depending on the level of experience of the reading physician.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Subtraction Coronary CT Angiography in Severely Calcified Segments: Comparison Between Readers With Different Levels of Experience

et al. 2022

Front. Cardiovasc. Med.

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PurposeSubtraction coronary CT angiography (CCTA) may reduce blooming and beam-hardening artifacts. This study aimed to assess its value in improving the diagnostic accuracy of readers with different experience levels.MethodWe prospectively enrolled patients with target segment who underwent CCTA and invasive coronary angiography (ICA). Target segment images were independently evaluated by three groups of radiologists with different experience levels with CCTA using ICA as the standard reference. Diagnostic accuracy was measured by the area under the curve (AUC), using ≥50% stenosis as the cut-off value.ResultsIn total, 134 target segments with severe calcification from 47 patients were analyzed. The mean specificity of conventional CCTA for each group ranged from 22.4 to 42.2%, which significantly improved with subtraction CCTA, ranging from 81.3 to 85.7% (all p < 0.001). The mean sensitivity of conventional CCTA for each group ranged from 83.3 to 88.0%. Following calcification subtraction, the mean sensitivity decreased for the novice (p < 0.001) and junior (p = 0.017) radiologists but was unchanged for the senior radiologists (p = 0.690). With subtraction CCTA, the mean AUCs of CCTA significantly increased: values ranged from 0.53, 0.54, and 0.61 to 0.70, 0.74, and 0.85 for the novice, junior, and senior groups (all p < 0.001).ConclusionSubtraction CCTA could improve the diagnostic accuracy of radiologists at all experience levels of CCTA interpretation.

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“…Data of patients who underwent CCTA from 1 March 2016 to 31 June 2021 in Padua University Hospital were retrospectively retrieved. According to guidelines [ 18 ], in our department, CCTA is requested for evaluation of asymptomatic patients or patients with stable (typical or atypical) chest pain, with a low to intermediate pre-test probability of obstructive CAD. We excluded patients with the following characteristics: age < 18 years; acute chest pain or ECG changes suggestive of ACS; CAD-RADS > 3; blooming artifacts for wide coronary calcification; history of previous cardiac surgery, coronary dissection, congenital heart disease, coronary origin anomaly; active coexisting inflammatory or oncological disease.…”

Section: Methodsmentioning

confidence: 99%

Added Value of CCTA-Derived Features to Predict MACEs in Stable Patients Undergoing Coronary Computed Tomography

et al. 2022

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Clinical evidence has emphasized the importance of coronary plaques’ characteristics, rather than lumen stenosis, for the outcome of cardiovascular events. Coronary computed tomographic angiography (CCTA) has a well-established role as a non-invasive tool for assessing plaques. The aim of this study was to compare clinical characteristics and CCTA-derived information of stable patients with non-severe plaques in predicting major adverse cardiac events (MACEs) during follow-up. We retrospectively selected 371 patients (64% male) who underwent CCTA in our center from March 2016 to January 2021 with Coronary Artery Disease—Reporting and Data System (CAD-RADS) 0 to 3. Of those, 198 patients (53% male) had CAD-RADS 0 to 1. Among them, 183 (49%) had normal pericoronary fat attenuation index (pFAI), while 15 (60% male) had pFAI ≥ 70.1 Hounsfield unit (HU). The remaining 173 patients (76% male) had CAD-RADS 2 to 3 and were divided into patients with at least one low attenuation plaque (LAP) and patients without LAPs (n-LAP). Compared to n-LAP, patients with LAPs had higher pFAI (p = 0.005) and had more plaques than patients with n-LAP. Presence of LAPs was significantly higher in elderly (p < 0.001), males (p < 0.001) and patients with traditional risk factors (hypertension p = 0.0001, hyperlipemia p = 0.0003, smoking p = 0.0003, diabetes p = <0.0001, familiarity p = 0.0007). Among patients with CAD-RADS 0 to 1, the ones with pFAI ≥ 70.1 HU were more often hyperlipidemic (p = 0.05) and smokers (p = 0.007). Follow-up (25,4 months, range: 17.6–39.2 months) demonstrated that LAP and pFAI ≥ 70.1 significantly and independently (p = 0.04) predisposed to outcomes (overall mortality and interventional procedures). There is an added value of CCTA-derived features in stratifying cardiovascular risk in low- to intermediate-risk patients with non-severe, non-calcified coronary plaques. This is of utmost clinical relevance as it is possible to identify a subset of patients with increased risk who need strengthening in therapeutic management and closer follow-up even in the absence of severe CAD. Further studies are needed to evaluate the effect of medical treatments on pericoronary inflammation and plaque composition.

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Coronary Computed Tomographic Angiography for Complete Assessment of Coronary Artery Disease

Cited by 94 publications

References 133 publications

Efficacy and safety of coronary computed tomography angiography in patients with a high clinical likelihood of obstructive coronary artery disease

Efficacy and safety of coronary computed tomography angiography in patients with a high clinical likelihood of obstructive coronary artery disease

Diagnostic Accuracy of Subtraction Coronary CT Angiography in Severely Calcified Segments: Comparison Between Readers With Different Levels of Experience

Added Value of CCTA-Derived Features to Predict MACEs in Stable Patients Undergoing Coronary Computed Tomography

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