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JCOM Abstract

J Clin Outcomes Manage 
2007 Aug;14(8):447-456
Coronary computed tomography angiography for the diagnosis of coronary artery disease
LaBounty T, Moscucci M, Kazerooni EA

Abstract Objective: To review the current application of coronary computed tomography angiography (CCTA) in the diagnosis of coronary artery disease (CAD). Methods: Qualitative review of the literature. Results: CCTA has emerged as a potential noninvasive alternative to both existing noninvasive tests for CAD in some patients and invasive coronary angiography (ICA) in other patients. There have been a large number of small, single-center studies comparing CCTA with ICA for the diagnosis of significant CAD that have reported excellent sensitivity, specificity, and negative predictive value in patient populations with a high prevalence of CAD. These studies often exclude segments or patients who do not have complete visualization of all coronary segments and it can be particularly challenging in patients with significant coronary artery calcification, stent placement, or coronary artery bypass grafts. A few small studies have evaluated the use of CCTA in the diagnosis of chest pain in the emergency department. Conclusion: To date, there are little data on the role of CCTA in comparison with other noninvasive tests for the diagnosis of CAD, including nuclear perfusion imaging and stress echocardiography. Given the ac-curacy of CCTA, it may be useful as a strategy to avoid ICA. The high negative predictive value of CCTA suggests great promise in the assessment of low- to moderate-risk patients with acute chest pain, with the potential for rapid patient triage and lower health care costs.

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