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01.06.2019 | Cardiac Computed Tomography (B Chow and G Small, Section Editors) | Ausgabe 6/2019

Current Cardiovascular Imaging Reports 6/2019

Coronary Computed Tomography Angiography as a Gatekeeper to Coronary Revascularization: Emphasizing Atherosclerosis Findings Beyond Stenosis

Zeitschrift:
Current Cardiovascular Imaging Reports > Ausgabe 6/2019
Autoren:
Inge J. van den Hoogen, Alexander R. van Rosendael, Fay Y. Lin, Jeroen J. Bax, Leslee J. Shaw, James K. Min
Wichtige Hinweise
Inge J. van den Hoogen and Alexander R. van Rosendael contributed equally to this work.
This article is part of the Topical Collection on Cardiac Computed Tomography

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Abstract

Purpose of Review

Coronary computed tomography angiography (CCTA) is the optimal non-invasive test to rule out coronary artery disease (CAD). Decisions to perform coronary revascularization have traditionally been based upon ischemia testing. This review summarizes the latest observations and trials evaluating the suitability of CCTA to select patients for invasive coronary angiography (ICA) and subsequent revascularization.

Recent Findings

Recent data shows that beyond stenosis, whole-heart quantification and characterization of coronary atherosclerotic plaque improves the estimation of myocardial ischemia. This comprehensive evaluation of the coronary artery tree has greater diagnostic accuracy for invasive fractional flow reserve (FFR) than conventional stress tests. Further, clinical trials have demonstrated that the performance of CCTA in patients with a clinical indication for ICA results in more effective patient care and significantly lower costs.

Summary

Besides the excellent ability to rule out CAD, recent data shows that quantification and characterization of the coronary artery tree results in high accuracy for ischemia and that CCTA-guided care to select patients for ICA and revascularization is effective. Trials evaluating revascularization based on CCTA findings may be needed.

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