What is the efficacy of CCTA for cardiac assessment?

Updated: Nov 20, 2018
  • Author: Richard S Krause, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

CCTA, coronary CT scanning using IV contrast and gating to allow visualization of the coronary artery lumen, is becoming more broadly used in the ED and for other outpatient settings. Studies have found good NPV for CCTA compared with the criterion standard of catheter angiography. A normal CCTA study (stenosis of < 50% is considered nonsignificant.) reliably rules out clinically significant stenosis and confers a low risk for these patients. [34] A 2-year follow-up study of CTCA patients found 25 adverse events (6.8%). There were no cardiac deaths, 12 MIs, and 23 revascularizations. [35]

The ROMICAT-II trial followed ED chest pain patients with negative initial troponin determinations and nonischemic ECG tracings for 28 days after being randomized to CCTA or standard treatment and found four with acute MI and two with unstable angina requiring coronary intervention from 495 patients in the standard evaluation group compared to one case each of MI and unstable angina from 501 patients in the CCTA group. Although the difference in adverse events was not statistically significant between the groups, the number of patients discharged from the ED and length of stay was significantly less in the CCTA group. [36]

At present, there is enough evidence to allow safe discharge from the ED of patients without acute ECG changes or elevated troponin levels, as well as with benign CCTA examinations. Of course, this assumes other serious causes of chest pain have been considered and excluded as needed.


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