Finding the Gatekeeper to the Cardiac Catheterization Laboratory: Coronary CT Angiography or Stress Testing?

Abstract:

:Functional capacity is a robust predictor of clinical outcomes, and stress testing is used in current practice paradigms to guide referral to invasive coronary angiography. However, invasive coronary angiography is driven by ongoing symptoms, as well as risk of adverse outcomes. The limitations of current functional testing-based paradigms might be avoided by using coronary computed tomographic angiography (CCTA) for exclusion of obstructive coronary artery disease. The growth of CCTA has been supported by comparative prognostic evidence with CCTA and functional testing, as well as radiation dose reduction. Use of CCTA for physiological evaluation of coronary lesion-specific ischemia may facilitate evaluation of moderate stenoses, designation of the culprit lesion, and prediction of benefit from revascularization. The potential of CCTA to serve as an effective gatekeeper to invasive coronary angiography will depend, in part, on the adoption of these new developments, as well as definition of the benefit of detecting high-risk plaque for guiding the management of selected patients.

journal_name

J Am Coll Cardiol

authors

Marwick TH,Cho I,Ó Hartaigh B,Min JK

doi

10.1016/j.jacc.2015.04.060

subject

Has Abstract

pub_date

2015-06-30 00:00:00

pages

2747-56

issue

25

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(15)02224-X

journal_volume

65

pub_type

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