Prognostic Value of Coronary CT Angiography

Cheezum, Michael K.; Hulten, Edward; Fischer, Collin; Smith, Ryan M.; Slim, Ahmad; Villines, Todd C.

doi:10.1016/j.ccl.2011.11.005

Cited by 11 publications

(11 citation statements)

References 81 publications

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“…Coronary CTA has emerged as a powerful tool for the diagnosis of CAD and has been shown in multiple large trials to exclude obstructive CAD with a high negative predictive value (>95 %) [ 37 ]. In practice, CTA relies on adequate patient preparation including heart rate control, administration of intravenous contrast, and utilization of high-resolution (≥64-slice) CT to optimally assess coronary plaque.…”

Section: Coronary Ctamentioning

confidence: 99%

“…Multiple studies have demonstrated a high sensitivity of CTA to detect CAD and prognostic value among low-intermediate patients with stable and acute symptoms concerning for ischemic heart disease [ 37 ]. Consequently, CTA is now incorporated among appropriate use criteria [ 22 ••] and guideline strategies [ 9 ••, 54 ] for the evaluation of low–intermediate-risk symptomatic patients.…”

Section: Coronary Ctamentioning

confidence: 99%

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Management of Coronary Artery Calcium and Coronary CTA Findings

Thomas

Divakaran

Villines

et al. 2015

Curr Cardiovasc Imaging Rep

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Coronary artery calcium (CAC) testing and coronary computed tomography angiography (CTA) have significant data supporting their ability to identify coronary artery disease (CAD) and classify patient risk for atherosclerotic cardiovascular disease (ASCVD). Evidence regarding CAC use for screening has established an excellent prognosis in patients with no detectable CAC, and the ability to risk re-classify the majority of asymptomatic patients considered intermediate risk by traditional risk scores. While data regarding the ideal management of CAC findings are limited, evidence supports statin consideration in patients with CAC > 0 and individualized aspirin therapy accounting for CAD risk factors, CAC severity, and factors which increase a patient’s risk of bleeding. In patients with stable or acute symptoms undergoing coronary CTA, a normal CTA predicts excellent prognosis, allowing reassurance and disposition without further testing. When CTA identifies nonobstructive CAD (<50 % stenosis), observational data support consideration of statin use/intensification in patients with extensive plaque (at least four coronary segments involved) and patients with high-risk plaque features. In patients with both nonobstructive and obstructive CAD, multiple studies have now demonstrated an ability of CTA to guide management and improve CAD risk factor control. Still, significant under-treatment of cardiovascular risk factors and high-risk image findings remain, among concerns that CTA may increase invasive angiography and revascularization. To fully realize the impact of atherosclerosis imaging for ASCVD prevention, patient engagement in lifestyle changes and the modification of ASCVD risk factors remain the foundation of care. This review provides an overview of available data and recommendations in the management of CAC and CTA findings.

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Section: Coronary Ctamentioning

confidence: 99%

Section: Coronary Ctamentioning

confidence: 99%

Management of Coronary Artery Calcium and Coronary CTA Findings

Thomas

Divakaran

Villines

et al. 2015

Curr Cardiovasc Imaging Rep

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“…Though CCTA requires specialized personnel and equipment that may not be widely available, data has demonstrated the potential for CCTA to reduce costs relative to standard of care primarily in its ability to reduce the time to diagnose patients in the ED setting [12]. Based on its excellent diagnostic accuracy, prognostic value [13, 14•, 15•], and potential to improve the early triage of ED patients, CCTA currently is given a class IIa indication to evaluate low-intermediate risk patients with suspected acute coronary syndrome (ACS) in whom follow-up 12-lead ECG and cardiac biomarkers are normal (Fig. 1) [16].…”

Section: Noninvasive Cardiac Testing – Current Approaches and Limitatmentioning

confidence: 99%

Coronary Artery Calcium Testing in Symptomatic Patients: An Issue of Diagnostic Efficiency

McBride

Cheezum

Gore

et al. 2013

Curr Cardiovasc Imaging Rep

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The detection and quantification of coronary artery calcification (CAC) significantly improves cardiovascular risk prediction in asymptomatic patients. Many have advocated for expanded CAC testing in symptomatic patients based on data demonstrating that the absence of quantifiable CAC in patients with possible angina makes obstructive coronary artery disease (CAD) and subsequent adverse events highly unlikely. However, the widespread use of CAC testing in symptomatic patients may be limited by the high background prevalence of CAC and its low specificity for obstructive CAD, necessitating additional testing (‘test layering’) in a large percentage of eligible patients. Further, adequately powered prospective studies validating the comparative effectiveness of a ‘CAC first’ approach with regards to cost, safety, accuracy and clinical outcomes are lacking. Due to marked reductions in patient radiation exposure and higher comparative accuracy and prognostic value make coronary computed tomographic angiography the preferred CT-based test for appropriately selected symptomatic patients.

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“…Kardiyak BT'nin en önemli avantajı koroner arter hastalığının ekarte edilmesindeki yüksek negatif öngörü değeri olmuştur ve bu açıdan tanısal değeri kateter anjiyografiden daha yük-sektir [18]. Erken ateroskleroz görüntülemede referans yöntem olan intravasküler ultrasonografiye en yakın görüntülemeyi sağlanmaktadır.…”

Section: Klinik çAlışmalarunclassified

“…Koroner BT Anjiyografinin Klinik Sonuçlar açısından Değerlendirilmesi: Uluslarası Çok Merkezli (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry CONFIRM) veri bankası, çalışmaları sonucunda yeni skorlama indeksleri kullanılmaya başlanmıştır [18]. Segment tutulum skoru (toplam ateroksleroz bulunan segment sayısı, en fazla 16 segment), segment stenoz skoru (her segmentte hafif, orta ve ağır stenoz olduğunda sırasıyla 1, 2, 3 ile derecelendirilmektedir ve tüm segmentlerin sonuçları toplanmaktadır) ve modifiye Duke prognostik indeks (sol ana koroner arter hastalığı, proksimal segment koroner arter aterosklerozu ve plak yaygınlığını değerlendi-ren) skoru, koroner BT anjiyografi ile yapılan prognostik çalışmalarda yeni kullanılmaya başlanan yöntemlerdir.…”

Section: Klinik çAlışmalarunclassified

Kardiyak Bilgisayarlı Tomografi’de Güncel Gelişmeler

Karçaaltıncaba¹

2013

Trd Sem

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Prognostic Value of Coronary CT Angiography

Cited by 11 publications

References 81 publications

Management of Coronary Artery Calcium and Coronary CTA Findings

Management of Coronary Artery Calcium and Coronary CTA Findings

Coronary Artery Calcium Testing in Symptomatic Patients: An Issue of Diagnostic Efficiency

Kardiyak Bilgisayarlı Tomografi’de Güncel Gelişmeler

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