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

Abstract

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.

Improving image quality and resolution of coronary arteries in coronary computed tomography angiography by using high-definition scans and deep learning image reconstruction

“…Coronary computed tomography angiography (CTA) is a powerful noninvasive imaging technology with a high temporal and spatial resolution that has improved risk stratification and management in patients with low-to-moderate coronary artery disease (CAD). Notably, coronary CTA is also an effective, safe, noninvasive, outpatient alternative to invasive coronary angiography (ICA) for patients with a high probability of clinically obstructive CAD ( 4 - 6 ).…”

Coronary computed tomography angiography assessment of relationship between right coronary artery-aorta angle and the development of coronary artery disease

“…However, subgroup analysis did not yield any significant differences between the RCA-aorta angles of normal cases, or those with <50% and ≥50% coronary stenosis. Degree of coronary stenosis is commonly used in the current literature to characterise CAD severity (25,26,(28)(29)(30). However, this alone is not necessarily indicative of ischemic severity, which is an inherent limitation for CCTA, as the degree of coronary stenosis does not always translate to the hemodynamic significance of coronary lesions.…”

The Diagnostic Performance of Coronary Computed Tomographic Angiography Compared With Invasive Coronary Angiography in Symptomatic Patients: Long–term Prognostic Implications

“…CCTA clearly provides high accuracy for detecting obstructive CAD, and the high NPV determines CCTA as an effective non-invasive imaging procedure to exclude significant CAD in all risk groups, including stable symptomatic patients and those with acute coronary syndrome (17)(18)(19)(20). A previous study showed that up to 80% of ICAs can be avoided for patients with a low prevalence of CAD, since CCTA can effectively determine the need for ICA (21)(22)(23).…”