TY - UNPB
T1 - Contemporary Chest Pain Evaluation
T2 - The Australian Case for Cardiac CT.
AU - Ihdayhid, AR
AU - Lan, Nick S. R.
AU - Figtree, GA
AU - Patel, S
AU - Arnott, Clare
AU - Hamilton-Craig, C
AU - Psaltis, PJ
AU - Leipsic, J
AU - Fairbairn, Timothy
AU - Wahi, S
AU - Hillis, GS
AU - Rankin, JM
AU - Dwivedi, G
AU - Nicholls, SJ
PY - 2023/3
Y1 - 2023/3
N2 - Computed tomography coronary angiography (CTCA) is a non-invasive diagnostic modality that provides a comprehensive anatomical assessment of the coronary arteries and coronary atherosclerosis, including plaque burden, composition and morphology. The past decade has witnessed an increase in the role of CTCA for evaluating patients with both stable and acute chest pain, and recent international guidelines have provided increasing support for a first line CTCA diagnostic strategy in select patients. CTCA offers some advantages over current functional tests in the detection of obstructive and non-obstructive coronary artery disease, as well as for ruling out obstructive coronary artery disease. Recent randomised trials have also shown that CTCA improves prognostication and guides the use of guideline-directed preventive therapies, leading to improved clinical outcomes. CTCA technology advances such as fractional flow reserve, plaque quantification and perivascular fat inflammation potentially allows for more personalised risk assessment and targeted therapies. Further studies evaluating demand, supply, and cost-effectiveness of CTCA for evaluating chest pain are required in Australia. This discussion paper revisits the evidence supporting the use of CTCA, provides an overview of its implications and limitations, and considers its potential role for chest pain evaluation pathways in Australia.
AB - Computed tomography coronary angiography (CTCA) is a non-invasive diagnostic modality that provides a comprehensive anatomical assessment of the coronary arteries and coronary atherosclerosis, including plaque burden, composition and morphology. The past decade has witnessed an increase in the role of CTCA for evaluating patients with both stable and acute chest pain, and recent international guidelines have provided increasing support for a first line CTCA diagnostic strategy in select patients. CTCA offers some advantages over current functional tests in the detection of obstructive and non-obstructive coronary artery disease, as well as for ruling out obstructive coronary artery disease. Recent randomised trials have also shown that CTCA improves prognostication and guides the use of guideline-directed preventive therapies, leading to improved clinical outcomes. CTCA technology advances such as fractional flow reserve, plaque quantification and perivascular fat inflammation potentially allows for more personalised risk assessment and targeted therapies. Further studies evaluating demand, supply, and cost-effectiveness of CTCA for evaluating chest pain are required in Australia. This discussion paper revisits the evidence supporting the use of CTCA, provides an overview of its implications and limitations, and considers its potential role for chest pain evaluation pathways in Australia.
UR - http://www.scopus.com/inward/record.url?scp=85146081220&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2022.12.003
DO - 10.1016/j.hlc.2022.12.003
M3 - Discussion paper
C2 - 36610819
VL - 32
T3 - Heart Lung and Circulation
SP - 297
EP - 306
BT - Contemporary Chest Pain Evaluation
PB - Elsevier
ER -