CT-first strategy the most effective path forward when evaluating stable chest pain
Ordering a coronary computed tomography angiography (CCTA) exam is the most effective first step when evaluating patients with stable chest pain, according to new research being presented at the American College of Cardiology (ACC) Cardiovascular Summit 2024 meeting in Washington, D.C.
CCTA has gained significant momentum in recent years, especially after updated chest pain guidelines released in 2021 by the ACC and American Heart Association gave the modality a Class 1A recommendation. CCTA is also noninvasive, widely available and relatively cheap compared to some other imaging modalities, making it even more appealing to heart teams throughout the United States.
Another factor that appears to be in CT’s favor is the fact that artificial intelligence models are already available that can help evaluate patients with suspected coronary artery disease (CAD). HeartFlow FFRCT Analysis, for example, first gained U.S. Food and Drug Administration approval back in 2014, and it was included in the 2021 chest pain guidelines as a potential treatment option.
What the latest data say about a CT-first strategy for stable chest pain
For this latest study, researchers examined data from nearly 800 patients who presented with stable chest pain from October 2022 to June 2023. All patients had no prior history of CAD and underwent elective invasive coronary angiography (ICA). Prior to ICA, 36% of patients underwent CCTA, 15% underwent myocardial perfusion imaging, 3% underwent stress echocardiograms, 2% underwent stress MRI exams and 44% underwent no additional noninvasive evaluations.
Overall, the CT-first strategy was linked to subsequent revascularization for 62% of patients. Among patients treated with all other approaches, however, just 34% of patients underwent a subsequent revascularization.
“While care must be individualized, for patients with unknown or unestablished coronary artery disease, the transition to a ‘CT-first’ strategy should be a high priority for cardiovascular care providers,” senior author Markus Scherer, MD, director of cardiac CT and structural heart imaging with the Atrium Health-Sanger Heart & Vascular Institute in Charlotte, North Carolina, said in a prepared statement from the ACC. “The non-invasive approach has a lower risk and cost than a diagnostic heart catheterization and, for the CT approach—but not stress testing—provides information on the absence, presence and extent of coronary atherosclerosis and whether or not there are high risk plaques as well as vessel blockages, which helps streamline patient management and risk reduction.”
Scherer also highlighted the fact that his team’s findings line up with the conclusions of a variety of large clinical trials, providing a “real-world” perspective on this ongoing trend.
“Cardiac catheterization labs are a capital and human resource intensive care environment. Using them for their maximum potential of treating disease, rather than diagnosing it, bring the highest yield for these resources to the health care system,” he said.
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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.