What are the indications for coronary computed tomography angiography (CCTA) in coronary artery disease (CAD)?

Updated: Dec 21, 2017
  • Author: Eugene C Lin, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

A 2008 scientific statement from the American Heart Association (AHA) [15] indicates that the potential benefit of noninvasive coronary angiography is likely to be the greatest for symptomatic patients who are at intermediate risk for coronary artery disease (CAD) after initial risk stratification, including patients with equivocal stress tests. CCTA is recommended over coronary magnetic resonance angiography (MRA) because of superior diagnostic accuracy. [16]

Neither coronary CTA nor magnetic resonance angiography (MRA) is recommended to screen for CAD in patients who have no signs or symptoms suggestive of CAD. In 7590 individuals without chest pain syndrome or history of CAD in the CONFIRM registry, the additional risk-predictive advantage of CCTA was not clinically meaningful compared with a risk model based on coronary calcium score alone. [17]

Results from the multicenter CONFIRM registry support that CCTA can be used effectively as a gatekeeper to invasive coronary angiography. [18]

Appropriateness criteria were published in 2010 from the combined efforts of 9 specialty societies. [1] The following indications (see the article for specific indications within the broad categories below) were rated as appropriate for CCTA:

  • Detection of CAD in symptomatic patients without known heart disease, either nonacute or acute presentations

  • Detection of CAD in patients with new onset or newly diagnosed clinical heart failure and no prior CAD

  • Preoperative coronary assessment prior to noncoronary cardiac surgery

  • Patients with prior ECG exercise testing - Normal test with continued symptoms or intermediate risk Duke treadmill score

  • Patients with prior stress imaging procedures - Discordant electrocardiographic (ECG) exercise and imaging results or equivocal stress imaging results

  • Evaluation of new or worsening symptoms in the setting of a past normal stress imaging study

  • Risk assessment post revascularization - Symptomatic if post coronary artery bypass grafting or asymptomatic with prior left main coronary stent greater than or equal to 3 mm

  • Evaluation of cardiac structure and function in adult congenital heart disease

  • Evaluation of cardiac structure and function - Ventricular morphology and systolic function

  • Evaluation of cardiac structure and function - Intracardiac and extracardiac structures


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