Coronary computed tomography angiography for the assessment of chest pain: current status and future directions

Abstract

Chest pain is one of the most common presenting symptoms leading to presentation to medical clinics and Emergency Departments worldwide. Defining the nature and etiology of chest pain can pose a diagnostic dilemma for clinicians, despite the availability of several diagnostic algorithms and guidelines to assist them in evaluating these patients. Most investigations in patients with acute chest pain are initially performed to either exclude or diagnose and manage potentially life-threatening conditions such as acute coronary syndrome, pulmonary embolism and aortic dissection. In cases of stable chest pain syndromes, the focus shifts to determining the presence, extent and severity of coronary artery disease. In recent years, coronary computed tomography angiography (CCTA) is being increasingly used worldwide in the assessment of both stable and acute chest pain syndromes. This review evaluates the current evidence regarding the clinical utility of CCTA in the stable and acute chest pain settings and outlines the latest advances in CCTA techniques, including functional assessment of coronary stenoses, and their potential clinical application to improve patient care in a cost-effective manner.

Coronary Computed Tomography Angiography for Assesment of Stable Coronary Artery Disease – a Cost-effectiveness Perspective

“…Stable chest pain is still a frequent clinical presentation to medical clinics and emergency departments worldwide. 1 This leads to an increased number of invasive or noninvasive investigations with the primary aim to identify or dismiss the existence of flow-limiting coronary artery disease (CAD). [2][3][4] This results in a continuous resource-consuming problem for healthcare providers worldwide, given the fact that CAD continues to represent the most frequent cause of health-related deaths in the European Union (EU) 5 and contributes to a consistent decrease in the quality of life.…”

“…6,7 In the setting of such extensive charges, the accuracy of CAD diagnosis remains of great importance for the management of these patients. 1 Despite efforts to reduce cardiovascular mor-tality in acute coronary syndrome (ACS) via advances in the management and implementation of up-to-date effective treatments, stable CAD continues to present high mortality rates. In the current clinical practice, invasive coronary angiography (ICA) has an essential role in the management of CAD subjects, being the current gold-standard for confirming the existence, location, and severity of CAD.…”

“…28,29 Another key beneift of CEA is represented by the fact that cost savings are defined in the presence of equivalent outcomes; thus, cost fluctuation does not actually result in a decrease of quality received by the patients. 30 Besides the currently available expansive economic evidence, there is still an important lingering issue: to establish, from the healthcare provider's point of view, the costefficiency of CCTA compared with the current guideline standard or other imaging techniques for the detection of significant coronary artery disease. 31…”