The evolving role of coronary CT angiography in Acute Coronary Syndromes

Abstract

In the United States, non-obstructive coronary disease has been on the rise, and each year, nearly one million adults suffer myocardial infarction, 70% of which are non-ST-segment elevation myocardial infarction (NSTEMI). In addition, approximately 15% of patients suffering NSTEMI will have subsequent readmission for a recurrent acute coronary syndrome (ACS). While invasive angiography remains the standard of care in the diagnostic and therapeutic approach to these patients, these methods have limitations that include procedural complications, uncertain specificity in diagnosis of the culprit lesion in patients with multi-vessel coronary artery disease (CAD), and challenges in following coronary disease over time. The role of coronary computed tomography angiography (CCTA) for evaluating patients with both stable and acute chest pain has seen a paramount upshift in the last decade. This paper reviews the established role of CCTA for the rapid exclusion of obstructive plaque in troponin negative acute chest pain, while exploring opportunities to address challenges in the current approach to evaluating NSTEMI.

Cardiac computed tomographic imaging in cardio-oncology: An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT). Endorsed by the International Cardio-Oncology Society (ICOS)

“…transient ECG abnormalities, mildly elevated troponin, wall motion abnormalities with no other significant findings) and stable chest pain syndrome. [80][81][82] The advantage of coronary CTA is its ability to detect obstructive coronary artery disease (CAD) and if present, permit timely initiation of treatment according to the current ACC/AHA guidelines. 80 Cancer therapy related thrombocytopenia and anemia places cancer patients at increased risk of access site related major bleeding complications from invasive procedures such as invasive coronary angiography.…”

Contemporary Risk Stratification of Acute Coronary Syndrome

“…[53][54][55] CCTA may identify up to 30% of patients with ACS presenting with positive troponin without obstructive CAD, and thus avoid the need for invasive angiography. 56,57 However, in patients who are experiencing a definite MI (or who have known CAD), CCTA should be avoided because direct referral to invasive angiography would be preferable. 58 In select cases, other imaging modalities, such as CMR, may be helpful in identifying the underlying cause for MI with non-obstructive CAD.…”

Coronary Computed Tomography Angiography Assessment of High-Risk Plaques in Predicting Acute Coronary Syndrome

“…To achieve high image quality should continue to be emphasized in the future, so as to accurately apply new methods such as functional assessment and plaque quantification to CCTA imaging (117). Moreover, artificial intelligence and machine learning methods may get more attention (118)(119)(120). Currently, emerging technologies such as CCTA-based identification of high-risk plaque features and FAI have not been verified in randomized controlled trials.…”