Following the evidence: The pre-eminent role of coronary CT angiography in 2021

Abstract

Eleven years ago, the first Appropriate Use Criteria (AUC) for the clinical use of cardiac computed tomography (CCT) was published. 1 Taylor A.J. Cerqueira M. Hodgson J.M. et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American college of Cardiology foundation appropriate use criteria task force, the society of cardiovascular computed tomography, the American college of radiology, the American heart association, the American society of echocardiography, the American society of nuclear Cardiology, the north American society for cardiovascular imaging, the society for cardiovascular angiography and interventions, and the society for cardiovascular magnetic resonance. J. Cardiovasc. Comput. Tomogr. 2010; 4: 407-433 Abstract Full Text Full Text PDF PubMed Google Scholar That document, largely based on expert opinion and studies that primarily assessed the diagnostic accuracy of coronary CT angiography (CTA) compared to invasive coronary angiography (ICA), summarized for the field the utilization of CCT across a number of established and potential clinical indications. The 2010 AUC has proven to be highly prescient despite being, at the time, limited by a lack of mature evidence for the use of coronary CTA in many of the considered scenarios. Since this time, the field of cardiovascular CT has undergone a degree of scientific investigation, technological advancement, and (eventually) clinical adoption that is unprecedented when compared to other non-invasive imaging modalities used for the diagnosis of coronary artery disease (CAD). As a result, the year 2021 is likely to be seminal for coronary CTA, with the publication of the United States chest pain guideline due imminently and the adoption and implementation of recent European and UK guidelines that recommend coronary CTA as the preferred 1st-line test in patients with acute and chronic chest pain syndromes. 2 National Institute for Health and Care Excellence Chest Pain of Recent Onset: Assessment and Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin. Clinical Guideline CG95. NICE, London2016 Google Scholar , 3 Collet J.P. Thiele H. Barbato E. et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020; 2020 Google Scholar , 4 Knuuti J. Wijns W. Saraste A. et al. ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2019; 41 (2020): 407-477 Crossref Scopus (1122) Google Scholar