Cardiology, radiology specialists debate CCTA’s rise as a go-to imaging modality for CAD
Coronary CT angiography (CCTA) is being used more and more all over the world to diagnose and manage patients with suspected coronary artery disease (CAD). In fact, the rise of artificial intelligence (AI) software designed to evaluate CCTA images has been one of the biggest stories in cardiovascular imaging in 2024—and that trend has shown no signs of slowing down.
Is CCTA’s increased utilization, often at the expense of invasive coronary angiography (ICA) utilization, a good thing for patient care? EuroIntervention, the official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions, asked experienced clinicians from the worlds of radiology and cardiology to weigh in on that very question.
One perspective: CCTA represents a ‘powerful diagnostic tool’ with several benefits
Marc Dewey, MD, a professor and vice chair of radiology at Charité – Universitätsmedizin Berlin shared a positive look at CCTA with help from Federico Biavati, MD, a radiology researcher at Charité. The two imagers detailed many benefits of CCTA, starting with its noninvasive nature and overall safety. The reduced risk of bleeding events, arterial injuries and other complications is a notable improvement, and one that makes CCTA “particularly suitable for patients at low-to-intermediate risk of CAD.”
Dewey and Biavati also discussed the high diagnostic accuracy of CCTA in addition to the “detailed visualization” it provides of the coronary arteries.
“Traditional tests focus on functional outcomes like ischemia, but CCTA directly visualizes atherosclerosis, providing more precise diagnoses,” they explained.
Another key takeaway from the duo’s analysis was the potential impact CCTA will have as AI is used more and more to identify subclinical atherosclerosis before symptoms are even fully visible. AI-powered CCTA evaluations, they wrote, could represent significant progress in terms of preventing adverse events.
“CCTA has solidified its position as a powerful diagnostic tool for CAD,” the two authors concluded. “Its non-invasive nature, high diagnostic accuracy, detailed plaque visualization, early detection capabilities and continuous technological advancements make it a formidable alternative to traditional invasive angiography.”
Another perspective: ICA remains the best imaging option
Alfredo Marchese, MD, PhD, chief of interventional cardiology at Santa Maria Hospital in Bari, Italy, and Roberta Rossini, MD, PhD, a cardiologist with S. Croce and Carle Hospital in Cuneo, Italy, provided a less enthusiastic look at the rapid rise of CCTA.
“The pros of CCTA, mainly based on its high negative predictive value, are strongly counteracted by the cons, including its low specificity, especially in identifying functionally significant CAD,” the two cardiologists wrote.
Marchese and Rossini also noted that CCTA is not universally recommended for certain patient groups, including those with decompensated heart failure and those with a fast irregular heart rate.
“The demonstrated benefits of CCTA should be reconsidered: what has been found in a highly selective population cannot be applied to all real-world patients,” they wrote.
The two cardiologists also suggested that the concerns some specialists have shared about ICA may not necessarily be relevant. Many prior studies focused on ICA included bare metal stents, for example, and the CONSERVE study found that CCTA and ICA were associated with comparable rates of adverse events and major bleeding events.[2]
Finally, Marchese and Rossini emphasized that they believe ICA is “one step above” CCTA because it represents “the standard of care” for all levels of acute coronary syndromes. They added that they still see ICA as a much better way to diagnose angina, even as more and more care teams are transitioning to the use of CCTA.
“So much promise, so little delivery (for CCTA),” they concluded. “Despite its appeal, the limits of CCTA strongly reduce its feasibility.”
Read the full debate here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.