CT should be used first to evaluate patients with stable chest pain who are suspected of having a heart attack. That’s the message of a paper being presented this week at the American College of Cardiology Cardiovascular Summit in Washington, DC.
CT is proving itself useful for a variety of applications in cardiac imaging, from predicting heart disease risk through coronary calcium scores to assessing whether people with chest pain need treatment like invasive angiography – or can be sent home and monitored.
- But cardiac CT often runs up against decades of clinical practice that relies on tools like stress testing or diagnostic invasive coronary angiography for evaluating patients, with the CT-first strategy reserved for a limited number of people, such as those with unestablished coronary artery disease.
But the new study suggests that the CT-first approach could be used for the vast majority of patients presenting with stable chest pain.
- A research team led by senior author Markus Scherer, MD, of Atrium Health-Sanger Heart & Vascular Institute in Charlotte, North Carolina tested the strategy in 786 patients seen from October 2022 to June 2023 who had no prior diagnosis of coronary artery disease and underwent elective invasive angiography to evaluate suspected angina.
The CT-first strategy compared CT angiography with provisional FFRCT testing to traditional evaluation pathways, which included stress echo, stress myocardial perfusion imaging, stress MRI, or no invasive testing before direct referral to angiography. Revascularization rates by strategy were as follows …
- 62% for CT-first
- 50% for stress MRI
- 40% for stress echo
- 34% for no prior test
- 31% for stress MPI
The results presented this week offer real-world evidence that support recent clinical studies backing broader use of CT for patients with chest pain. Given CT’s advantages in terms of cost and noninvasiveness, the findings raise the question of whether more can be done to get clinicians to adhere to established guidelines calling for a CT-first protocol.