RT Journal Article
SR Electronic
T1 CT coronary angiographic evaluation of suspected anginal chest pain
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 263
OP 268
DO 10.1136/heartjnl-2015-307860
VO 102
IS 4
A1 Alastair J Moss
A1 David E Newby
YR 2016
UL http://heart.bmj.com/content/102/4/263.abstract
AB Non-invasive imaging plays a critical role in the assessment of patients presenting with suspected angina chest pain. However, wide variations in practice across Europe and North America highlight the lack of consensus in selecting the appropriate first-line test for the investigation of coronary artery disease (CAD). CT coronary angiography (CTCA) has a high negative predictive value for excluding the presence of CAD. As such, it serves as a potential ‘gatekeeper’ to downstream testing by reducing the rate of inappropriate invasive coronary angiography. Two recent large multicentre randomised control trials have provided insights into whether CTCA can be incorporated into chest pain care pathways to improve risk stratification of CAD. They demonstrate that using CTCA enhances diagnostic certainty and improves the targeting of appropriate invasive investigations and therapeutic interventions. Importantly, reductions in cardiac death and non-fatal myocardial infarction appear to be attained through the more appropriate use of preventative therapy and coronary revascularisation when guided by CTCA. With this increasing portfolio of evidence, CTCA should be considered the non-invasive investigation of choice in the evaluation of patients with suspected angina pectoris due to coronary heart disease.Clinical trial number NCT01149590, post-results.