![]() Indeed, the presence of nonobstructive disease on coronary CTA is associated with an increased risk of mortality when compared with those with no CAD (hazard ratio 1.60 95% confidence interval, 1.18-2.16 p = 0.002), 3 and the use of statin therapy has been associated with a reduction in mortality in this population. This feature allows treatments to be directed to and intensified in patients with coronary atherosclerosis, including therapies such as statins, aspirin, and recommendations for lifestyle changes. Detection of nonobstructive CAD provides an opportunity to improve outcomes in individuals with mild disease that would not be detected by stress testing and may not be detected even by invasive angiography. 4,5īeyond the identification or exclusion of stenosis, coronary CTA allows the detection of nonobstructive atherosclerosis that is not identified by ischemia testing. 3 It is estimated that the rate of myocardial infarction or cardiac death remains less than 1% per year for at least 8 years, providing an opportunity to offer reassurance to patients while potentially avoiding unnecessary downstream hospital visits and investigations. ![]() 2 In addition to ruling out obstructive stenosis, the absence of coronary disease on CTA is associated with an excellent prognosis with very low rates of adverse cardiac events extending over the following 5 years, often referred to as a "warranty period." In initial large prognostic studies, the absence of disease on coronary CTA over a mean of 3 years was associated with a mean annualised all-cause mortality rate of 0.28%. The associated very high negative predictive value is a powerful attribute of coronary CTA. Of note, coronary CTA is very unlikely to "miss" patients with highest risk CAD, such as those with left main or proximal left anterior descending artery stenosis. The sensitivity for the detection of significant CAD is superior to any other noninvasive modality in both a per-patient and per-vessel basis, highlighting its utility in identifying significant CAD. Since 64-slice coronary CTA first became commercially available in 2005, multiple studies have documented its high accuracy in the detection and exclusion of coronary disease that would be considered obstructive on invasive coronary angiography. 1 The ability of coronary CTA to provide anatomic information regarding the presence or absence of stenosis, disease burden, and plaque composition without subjecting patients to an invasive procedure has led to the proposal that its use may provide a superior strategy for the initial evaluation of symptomatic patients with suspected CAD, particularly those with a low-intermediate pre-test likelihood of CAD. Indeed, in a national registry of over 600 centres including approximately 400,000 patients, almost two thirds of patients had normal or nonobstructive disease on invasive angiography, when a stenosis of >70% was considered significant. The documented high rate of normal diagnostic invasive angiograms has highlighted the fact that current diagnostic strategies used to guide referrals to the catheterization laboratory are suboptimal. In this brief review, we discuss the role of coronary CTA in both the anatomic and functional assessment of CAD and explore whether diagnostic coronary catheterization is a way of the past. These applications now extend beyond conventional assessments of anatomic severity of coronary artery disease (CAD) to include evaluation of coronary plaque and the physiological consequences of coronary atherosclerosis. In recent years, the evolution of coronary computed tomography angiography (CTA) has heralded its transition from a limited role in the exclusion of obstructive disease in selected low-risk patients to the forefront of cardiovascular imaging with diverse applications.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |