Prognostic Value of Coronary CTA in Stable Chest Pain

Bittner, Daniel O.; Mayrhofer, Thomas; Budoff, Matt; Szilveszter, Bálint; Foldyna, Borek; Hallett, Travis R.; Ivanov, Alexander; Janjua, Sumbal; Meyersohn, Nandini M.; Staziaki, Pedro V.; Achenbach, Stephan; Ferencik, Maros; Douglas, Pamela S.; Hoffmann, Udo; Lu, Michael T.; Investigators, Promise

doi:10.1016/j.jcmg.2019.09.012

Cited by 69 publications

(32 citation statements)

References 32 publications

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“…Clinical models that incorporate information on risk factors for cardiovascular disease, resting electrocardiogram (ECG) changes (Q-wave and changes in ST-segment or T-wave), LV dysfunction suggestive of CAD, findings of exercise ECG or coronary calcification provide improved identification of patients with obstructive CAD compared with age, sex, and symptoms alone [13][14][15][16]. The absence of coronary calcium (Agatston score = 0) is associated with a low prevalence of obstructive CAD (<5%) and a low risk of death or non-fatal MI (<1% annual risk; [17,18]). However, coronary calcium detection by computed tomography is not recommended for identifying individuals with obstructive CAD [1].…”

Section: Ptp and Clinical Likelihood Of Cadmentioning

confidence: 99%

ESC 2019 guidelines for the diagnosis and management of chronic coronary syndromes

Saraste

Knuuti

2020

Herz

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The European Society of Cardiology (ESC) has recently published new guidelines on the diagnosis and management of chronic coronary syndromes (CCS). Due to variable symptoms, objective tests are often necessary to confirm the diagnosis, exclude alternative diagnoses, and assess the severity of underlying disease. This review provides a summary of the main diagnostic strategies listed in the guidelines for evaluation of patients suspected of having obstructive coronary artery disease (CAD). Based on data from contemporary cohorts of patients referred for diagnostic testing, the pre-test probabilities of obstructive CAD based on age, sex, and symptoms have been adjusted substantially downward compared with the previous guidelines. Further, a new concept of “clinical likelihood of CAD” was introduced accounting for the impact of various risk factors and modifiers on the pre-test probability. Noninvasive functional imaging for myocardial ischemia, coronary computed tomography angiography, or invasive coronary angiography combined with functional evaluation is recommended as the initial strategy to diagnose CAD in symptomatic patients, unless obstructive CAD can be excluded by clinical assessment alone. When available, imaging tests are recommended as noninvasive modalities instead of exercise electrocardiograms.

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Section: Ptp and Clinical Likelihood Of Cadmentioning

confidence: 99%

ESC 2019 guidelines for the diagnosis and management of chronic coronary syndromes

Saraste

Knuuti

2020

Herz

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“…Diversos estudios avalan el uso de la ATC como prueba diagnóstica, siendo un referente inicial el estudio CONFIRM (22) donde la presencia de estenosis moderada o severa fue menor a la esperada, según la estratificación realizada por probabilidad pretest. Años después, el estudio PROMISE (23) demostró que la ATC es una alternativa relevante a las pruebas funcionales en riesgo bajo a intermedio de SCC; sin encontrarse diferencias significativas en mortalidad e infarto de miocardio. Un subanálisis del mismo estudio demostró que el score de calcio posee una capacidad discriminatoria de eventos primarios (mortalidad, IM no fatal, hospitalización por angina inestable) similar a las pruebas funcionales (18) .…”

Section: Diagnósticounclassified

“…El etilo de icosapento, un ácido graso omega 3 altamente purificado, que reduce el nivel de triglicéridos ello debido a su enfoque en la evaluación de la aterosclerosis y las características de la placa (22,23) .…”

Section: Nuevas Terapiasunclassified

¿Debo tratar un síndrome coronario crónico de alto riesgo invasivamente desde el inicio? No, en la mayoría de casos

Rueda¹,

Olivares²,

Perez³

et al. 2020

APCyCCV

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La definición de síndrome coronario crónico de alto riesgo varía según la prueba no invasiva empleada para evidenciar isquemia, lo que se consigue a través de un aumento del trabajo miocárdico y la demanda de oxígeno, generados con el uso de fármacos o el ejercicio. El abordaje inicial nos sumerge en la discusión de contextualizar en qué casos priorizar la terapia médica óptima inicial, frente al manejo invasivo inicial con el objetivo de lograr la revascularización miocárdica. Este aspecto central será desarrollado en esta revisión, tomando en cuenta diversos estudios realizados hasta la fecha, en los que el manejo invasivo inicial no ha demostrado ser superior a la terapia médica óptima inicial en resultados clínicos relevantes como muerte o eventos adversos cardiovasculares mayores.

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“…CAD-RADS 4 category is divided into two subcategories: subcategory 4A includes severe stenosis (70–99%) of one or two coronary arteries, while subcategory 4B indicates left main artery stenosis >50% or obstructive disease of the three vessels (stenosis ≥ 70%) [ 71 , 73 , 74 ]. In patients with CAD-RADS 4A, a functional evaluation or ICA should be considered; in those with CAD-RADS 4B, invasive coronary angiography is recommended.…”

Section: Introductionmentioning

confidence: 99%

“…CAD-RADS categories can be supplemented by four modifiers that are added to specify whether a study is not fully evaluable or non-diagnostic (N) or to indicate the presence of stents (S) or grafts (G) and to report a vulnerable plaque (V). The “V” modifier should be added to the CAD-RADS category when an atherosclerotic lesion has two or more high-risk plaque features including positive remodeling, low attenuation plaque, spotty calcification, or napkin-ring sign [ 74 ].…”

Section: Introductionmentioning

confidence: 99%

The Radiologist as a Gatekeeper in Chest Pain

Pradella

Zantonelli

Grazzini

et al. 2021

IJERPH

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Chest pain is a symptom that can be found in life-threatening conditions such as acute coronary syndrome (ACS). Those patients requiring invasive coronary angiography treatment or surgery should be identified. Often the clinical setting and laboratory tests are not sufficient to rule out a coronary or aortic syndrome. Cardiac radiological imaging has evolved in recent years both in magnetic resonance (MR) and in computed tomography (CT). CT, in particular, due to its temporal and spatial resolution, the quickness of the examination, and the availability of scanners, is suitable for the evaluation of these patients. In particular, the latest-generation CT scanners allow the exclusion of diagnoses such as coronary artery disease and aortic pathology, thereby reducing the patient’s stay in hospital and safely selecting patients by distinguishing those who do not need further treatment from those who will need more- or less-invasive therapies. CT additionally reduces costs by improving long-term patient outcome. The limitations related to patient characteristics and those related to radiation exposure are weakening with the improvement of CT technology.

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Prognostic Value of Coronary CTA in Stable Chest Pain

Cited by 69 publications

References 32 publications

ESC 2019 guidelines for the diagnosis and management of chronic coronary syndromes

ESC 2019 guidelines for the diagnosis and management of chronic coronary syndromes

¿Debo tratar un síndrome coronario crónico de alto riesgo invasivamente desde el inicio? No, en la mayoría de casos

The Radiologist as a Gatekeeper in Chest Pain

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