The American College of Cardiology recommends the United States join Europe in using this test first with this patient population.
Using coronary CT angiography to evaluate patients who have stable chest pain can improve their outcomes, as well as lower their costs, a group of experts have said.
In the September issue of the Journal of the American College of Cardiology, experts from the American College of Cardiology (ACC) published recommendations that point to a need to shift away from other tests toward greater coronary CTA use.
This guidance, based on the expert consensus from the ACC Summit on Technology Advances in Coronary Computed Tomography Angiography, reflects evidence showing that for patients with no known coronary artery disease, detection of the condition should pivot from identifying myocardial perfusion abnormality to pinpointing coronary atherosclerosis through CTA-first. Europe has already changed their guidelines based on these recommendations and evidence.
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“In countries around the world, cardiac CT has been adopted as a first-line diagnostic test in patients with stable chest pain,” said Koen Nieman, M.D., Ph.D., Summit president, “and I have no doubt this strategy will be embraced in the U.S. as well if appropriate conditions can be established.”
Currently the U.S. ratio of SPECT myocardial perfusion imaging to coronary CTA testing is 58:1.
To move the industry toward coronary CTA-first, the ACC made these recommendations:
The ACC did caution, however, that more wide-spread use of CTA does present challenges.
Although CT scanners are widely available, greater CTA implementation calls for more education and training of medical professionals (both radiologists and cardiologists) to ensure they capture images of high diagnostic quality. In addition, providers need higher reimbursement for the service, and improvements must be made with insurance pre-authorizations.