Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Extract

In recent years, coronary computed tomography angiography (CCTA) has come to the forefront in the evaluation of patients with chest pain.1 Multiple large scale randomized clinical trials (RCT) confirmed its high sensitivity and negative predictive value.2,3In addition, multicentre registries and RCTs confirmed its ability to triage patients with acute and chronic chest pain.4,5 Its high negative predicative value resulted in a low rate of referral to coronary angiography over a 3-year period in patients with normal or non-obstructive disease.6 However, its ability to accurately quantify stenotic lesions and obstructive CAD, particularly in intermediate lesions, is limited.7,8 This is expected to increase post-CCTA resource utilization especially in patients with intermediate lesions. Data from the Medicare claims data in the USA suggested that using CCTA as the assessment tool of Medicare patients was associated with increased referral to the coronary angiography compared to other non-invasive modalities.9 Similarly, a meta-analysis of RCT of CCTA in acute chest pain showed increased rate of angiography and revascularization without impacting outcomes.10 This could be in part due to the fact that anatomical stenosis does not necessarily correlate with haemodynamically significant stenosis. In the FAME study, 65% of angiographically intermediate lesions were not haemodynamically significant while 20% of initially thought obstructive (71–90%) anatomical lesions had normal fractional flow reserve (FFR).11

Issue Section:
Editorial
You do not currently have access to this article.
Download all slides