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

  • Cardiac Computed Tomography (B Chow and G Small, Section Editors)
  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

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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Abbreviations

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

FFR:

Fractional flow reserve

FFR-CT:

Fractional flow reserve derived from computed tomography

HU:

Hounsfield units

ICA:

Invasive coronary angiography

PCI:

Percutaneous coronary intervention

PET:

Positron emission tomography

QCA:

Quantitative coronary angiography

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Author notes

  1. Inge J. van den Hoogen and Alexander R. van Rosendael contributed equally to this work.

Authors and Affiliations

  1. Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA

    Inge J. van den Hoogen, Alexander R. van Rosendael, Fay Y. Lin, Leslee J. Shaw & James K. Min

  2. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands

    Inge J. van den Hoogen & Jeroen J. Bax

Authors
  1. Inge J. van den Hoogen
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  2. Alexander R. van Rosendael
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Corresponding author

Correspondence to James K. Min.

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Conflict of Interest

Inge J. van den Hoogen declares no conflict of interest.

Alexander R. van Rosendael declares no conflict of interest.

Fay Y. Lin declares no conflict of interest.

Jeroen J. Bax declares no conflict of interest.

Leslee J. Shaw declares no conflict of interest.

James Min receives grant support from GE Healthcare, serves on the advisory board for Arineta, and retains equity interest for Cleerly Inc.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Cardiac Computed Tomography

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van den Hoogen, I.J., van Rosendael, A.R., Lin, F.Y. et al. Coronary Computed Tomography Angiography as a Gatekeeper to Coronary Revascularization: Emphasizing Atherosclerosis Findings Beyond Stenosis. Curr Cardiovasc Imaging Rep 12, 24 (2019). https://doi.org/10.1007/s12410-019-9497-1

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  • DOI: https://doi.org/10.1007/s12410-019-9497-1

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