Why cardiologists and radiologists are choosing cardiac CT over invasive angiography for suspected CAD
![Cardiac computed tomography (CCT) is an accurate, noninvasive imaging test that should be a first-line tool when treating patients with obstructive coronary artery disease (CAD), rather than cath lab angiography angiograms, according to new findings published in the New England Journal of Medicine.[1]](/sites/default/files/styles/top_stories/public/2022-04/ct_scan_tech_in_control_room_duly_df.jpeg.webp?itok=EzRZOE4n)
Cardiac computed tomography (CCT) is an accurate, noninvasive imaging test that should be a first-line tool when treating patients with obstructive coronary artery disease (CAD), according to new findings published in the New England Journal of Medicine.[1]
The study’s authors compared CCT to invasive coronary angiography (ICA) to gain a better understanding of which technique would make a more effective initial diagnostic imaging strategy for patients presenting with stable chest pain.
“ICA is the reference standard for the diagnosis of obstructive CAD and enables coronary revascularization during the same procedure,” wrote first author Pál Maurovich-Horvat, MD, PhD, of the Heart and Vascular Center and Medical Imaging Center at Semmelweis University in Hungary, and colleagues. “However, elective ICA is associated with rare but major procedure-related complications and has been reported to reveal obstructive CAD in only 38% to 50% of the patients who are referred for the procedure in the United States and Europe.”
Maurovich-Horvat et al. examined data from more than 3,500 patients who were treated at one of 26 European facilities from October 2015 to April 2019. All patients were at least 30 years old, and the mean patient age was 60.1 years old. Fifty-six percent of patients were women. The median follow-up period was 3.5 years.
While 1,833 patients were randomly chosen to undergo CCT as their initial imaging test, 1,834 underwent ICA. Major adverse cardiovascular events were reported in 2.1% of CCT patients and 3% of ICA patients. Clinical outcomes, meanwhile, were similar between the two groups.
Major procedure-related complications, the authors added, were seen in 0.5% of CCT patients and 1.9% of ICA patients.
“The risk of major complications from ICA procedures was four times as high among the patients who had undergone revascularization as among those who had not undergone revascularization,” the authors wrote.
Reviewing the 2021 chest pain guidelines
These findings support updates made to the 2021 chest pain guidelines published by members of the American Heart Association, American College of Cardiology, American Society of Echocardiography, American College of Chest Physicians, Society for Academic Emergency Medicine, Society of Cardiovascular Computed Tomography (SCCT), and Society for Cardiovascular Magnetic Resonance.
One of the biggest changes made to those guidelines was the inclusion of CCT as a first-line test for patients presenting with chest pain.
Support from the SCCT
Eric Williamson, MD, a professor of radiology at the Mayo Clinic in Rochester, Minnesota, and president of the SCCT discussed the potential impact of these findings in a prepared statement.
“This study reaffirms that coronary CT angiography should be the first-line test for patients presenting with chest pain,” he said. “It is safe, effective and quick. A CT-first strategy allows physicians to provide relevant findings without the need for an invasive procedure. This is especially important for people who do not have obstructive CAD.”
Hear more about the guidelines from Williamson in the VIDEO: The new role of cardiac CT under the 2021 chest pain evaluation guidelines.
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Reference:
1. The DISCHARGE Trial Group. CT or Invasive Coronary Angiography in Stable Chest Pain. NEJMoa2200963.
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.