The Big Picture: Evidence Base and Current Trials in Cardiac CT

Abstract

Cardiac computed tomography angiography (CCTA) has technically matured into a robust imaging modality for various cardiac disorders. Whereas early trials focused on assessment of the efficacy of CCTA in comparison with established recommended methods, current research efforts focus on the effectiveness of the technique in specific clinical scenarios. In this article, we provide an overview of recent technology advances, describe major clinical scenarios in which CCTA has been evaluated, and detail pertinent evidence from completed or ongoing clinical trials, including its use to investigate acute chest pain, its use among patients with stable chest pain syndrome, and its prognostic value for the occurrence of cardiovascular events.

Keywords: Acute coronary syndrome; Cardiac CT; Clinical trials; Prognosis; Stable coronary artery disease.

Fig. 1

Length of stay in the hospital and proportion of patients discharged as observed in the ROMICAT II trial [••]. There was a significant difference between observed discharged rate in the strategy implementing cardiac computed tomography angiography (CCTA) (blue) compared with standard evaluation in the emergency department (red), resulting in significantly lower median length of stay in the CT-based strategy. From Ref. [••], with permission

Fig. 2

All-cause three-year survival according to the presence, extent, and severity of cardiac computed tomography findings from the CONFIRM sample [••]. A dose–response relationship of mortality with increasing numbers of vessels with obstructive coronary artery disease (CAD) was observed. From Ref. [••], with permission