Coronary Computed Tomography Angiography in Stable Chest Pain: Recent Trials-Guidelines

Mustafa M. BARIŞa
aDokuz Eylül University Faculty of Medicine, Department of Radiology, İzmir, Türkiye

Barış MM. Coronary computed tomography angiography in stable chest pain: Recent trials-guidelines. In: Bayraktaroğlu S, ed. Advances in Cardiovascular System Imaging. 1st ed. Ankara: Türkiye Klinikleri; 2024. p.12-6.

ABSTRACT
Stable angina pectoris is considered as a common initial presentation of coronary artery related myocardial ischemia. Coronary computed tomography angiography (CTA) is one of the initial anatomic imaging techniques in stable chest pain along with invasive coronary angiography (ICA) and other non-anatomic but functional tests. There are initially three important trials (The PROMISE trial, The SCOT-HEART trial and The DISCHARGE Trial) comparing CTA with functional tests and ICA in stable angina. In this article, we aim to discuss coronary CTA as an initial investigation and a possible gate-keeper anatomic test in stable chest pain, under the lights of recent trials and guidelines including the three important trials mentioned above.

Keywords: Angina, stable; coronary angiography; cardiac-gated imaging techniques; computed tomography angiography

Referanslar

  1. Hemingway H, Langenberg C, Damant J, Frost C, Pyörälä K, Barrett-Connor E. Prevalence of angina in women versus men: a systematic review and meta-analysis of international variations across 31 countries. Circulation. 2008;117(12):1526-36. [Crossref]
  2. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6-e245.
  3. Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e368-e454. [Crossref]
  4. Douglas PS, Hoffmann U, Lee KL, Mark DB, Al-Khalidi HR, Anstrom K, et al. PROMISE investigators. PROspective Multicenter Imaging Study for Evaluation of chest pain: rationale and design of the PROMISE trial. Am Heart J. 2014;167(6):796-803.e1. [Crossref]
  5. DISCHARGE Trial Group; Maurovich-Horvat P, Bosserdt M, Kofoed KF, Rieckmann N, Benedek T, Donnelly P, et al. CT or Invasive Coronary Angiography in Stable Chest Pain. N Engl J Med. 2022;386(17):1591-602. [Crossref]
  6. Timmis A, Townsend N, Gale CP, Torbica A, Lettino M, Petersen SE, et al. European Society of Cardiology. European Society of Cardiology: Cardiovascular Disease Statistics 2019. Eur Heart J. 2020;41(1):12-85. [Crossref]
  7. Gorenoi V, Schönermark MP, Hagen A. CT coronary angiography vs. invasive coronary angiography in CHD. GMS Health Technol Assess. 2012;8:Doc02.
  8. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-77. [Crossref]
  9. Hoffmann U, Ferencik M, Udelson JE, Picard MH, Truong QA, Patel MR, et al. Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial. Circulation. 2017;135(24):2320-32. [Crossref]
  10. Douglas PS, Hoffmann U, Patel MR, Mark DB, Al-Khalidi HR, Cavanaugh B, et al. Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease. N Engl J Med. 2015;372(14):1291-300. [Crossref]
  11. Newby D, Williams M, Hunter A, Pawade T, Shah A, Flapan A, et al. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial . Lancet. 2015;385:2383-91. [Crossref]
  12. Newby D, Adamson PD, Berry C, Boon NA, Dweck MR, Flather M, et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med 2018;379:924-33. [Crossref]
  13. Mohamed M, Bosserd M, Wieske V, Dubourg B, Alkadhi H, Garcia MJ, et al. Combination of computed tomography angiography with coronary artery calcium score for improved diagnosis of coronary artery disease: a collaborative meta‑analysis of stable chest pain patients referred for invasive coronary angiography. European Radiology. 2024;34:2426-36. [Crossref]
  14. Lubbers M, Dedic A, Coenen A, Galema T, Akkerhuis J, Bruning T, et al. Calcium imaging and selective computed tomography angiography in comparison to functional testing for suspected coronary artery disease: the multicentre, randomized CRESCENT trial. European Heart Journal. 2016;37;1232-43. [Crossref]
  15. McKavanagh P, Lusk L, Ball PA, Verghis RM, Agus AM, Trinick TR, et al. A comparison of cardiac computerized tomography and exercise stress electrocardiogramtest for the investigation of stable chest pain: the clinical results of the CAPP randomized prospective trial. European Heart Journal - Cardiovascular Imaging. 2015;16;441-8. [Crossref]
  16. Zhang X, Zhang B, Zhang F. Stenosis Detection and Quantification of Coronary Artery Using Machine Learning and Deep Learning. Angiology. 2024;75(5):405-16. [Crossref]
  17. Choi AD, Marques H, Kumar V, Griffin VF, Rahban H, Karlsberg RP, et al. CT Evaluation by Artificial Intelligence for Atherosclerosis, Stenosis and Vascular Morphology (CLARIFY): A Multi-center, international study. Journal of Cardiovascular Computed Tomography. 2021;15:470-6. [Crossref]
  18. Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, et al. CAD-RADS™ 2.0 - 2022 Coronary Artery Disease - Reporting and Data System An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR) and the North America Society of Cardiovascular Imaging NASCI). Radiology: Cardiothoracic Imaging. 2022;4(5):e220183. [Crossref]
  19. Williams MC, Moss AJ, Dweck M, Adamson PD, Alam S, Hunter A, et al. Coronary Artery Plaque Characteristics Associated With Adverse Outcomes in the SCOT-HEART Study. JACC. 2019;73(3):291-301. [Crossref]
  20. Dodd JD, Leipsic JA. Evolving Developments in Cardiac CT. Radiology 2023;307(3):e222827 [Crossref]
  21. Kwiecinski J, Wolny R, Chwala A, Slomka P. Advances in the Assessment of Coronary Artery Disease Activity with PET/CT and CTA. Tomography 2023;9: 328-41. [Crossref]
  22. Knuuti J, Ballo H, Juarez-Orozco LE, Saraste A, Kolh P, Rutjes AWSR, et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta analysis focused on post-test disease probability European Heart Journal. 2018;39;3322-30. [Crossref]