Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study

Andreini, Daniele; Mushtaq, Saima; Conte, Edoardo; Sonck, Jeroen; Collet, Carlos; Guglielmo, Marco; Baggiano, Andrea; Trabattoni, Daniela; Galli, Stefano; Montorsi, Piero; Ferrari, Cristina; Fabbiocchi, Franco; Martini, Stefano De; Annoni, Andrea; Mancini, Maria Elisabetta; Formenti, Alberto; Magatelli, Marco; Resta, Marta; Consiglio, Elisa; Muscogiuri, Giuseppe; Fiorentini, Cesare; Bartorelli, Antonio L.; Pepi, Mauro

doi:10.1016/j.jcct.2018.06.003

Cited by 11 publications

(5 citation statements)

References 28 publications

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“…Importantly, the incremental value of additional CTP was demonstrated in patients across a wide spectrum of pre-test probabilities and coronary artery calcification [18]. The application of CTP is particularly interesting in the evaluation of patients with previous PCI in the light of the limited diagnostic accuracy of CTA in this patient subgroup [22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

“…Diagnostic accuracy of CTA, CTP, and CTA + CTP was assessed in stent-, territory-, and patient-based analyses. Further details on the study design, patient population, and CT scan protocols have been reported previously [22,24]. Andreini et al concluded that CTP demonstrated significantly higher diagnostic rate (96% vs. 68%) and diagnostic accuracy (86.7% vs. 76.7%) as compared with coronary CTA [22].…”

Section: Diagnostic Accuracy Parametersmentioning

confidence: 96%

“…Model input parameters were derived from systematic review of recent literature ( Table 1). The pre-test probability of a stenosis requiring PTCA in patients with clinical suspicion of ISR or CAD progression was set to 62.67% in accordance with the literature [22,24].…”

Section: Input Parametersmentioning

confidence: 99%

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Cost-effectiveness of stress CTP versus CTA in detecting obstructive CAD or in-stent restenosis in stented patients

et al. 2020

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Objectives The aim of this retrospective study was to determine cost-effectiveness of stress myocardial CT perfusion (CTP), coronary CT angiography (CTA), and the combination of both in suspected obstructive coronary artery disease (CAD) or in-stent restenosis (ISR) in patients with previous coronary stent implantation. Methods A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with CTA, CTP, and CTA + CTP. Model input parameters were obtained from published literature. Probabilistic sensitivity analysis was performed to evaluate overall model uncertainty. A single-variable deterministic sensitivity analysis evaluated the sensitivity of the results to plausible variations in model inputs.

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Section: Discussionmentioning

confidence: 99%

Section: Diagnostic Accuracy Parametersmentioning

confidence: 96%

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Cost-effectiveness of stress CTP versus CTA in detecting obstructive CAD or in-stent restenosis in stented patients

et al. 2020

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“…This technique can also improve the performance of CCTA in patients with previously implanted metallic stents, as recently demonstrated by the ADVANTAGE (Additional Diagnostic Value of CT perfusion over coronary CT Angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) study. This study enrolled 150 patients previously treated with PCI who underwent both stress CTP + CCTA and ICA, suggesting that CTP significantly improves the diagnostic accuracy of CCTA alone [123]. The dynamic CTP ("shuttle-mode" technique) added to the anatomical evaluation, increases the per-vessel specificity and positive predictive value of CCTA [124].…”

Section: Stress Ctpmentioning

confidence: 99%

The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes

Baessato

Guglielmo

Muscogiuri

et al. 2020

JCM

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In the context of chronic coronary syndromes (CCS), coronary computed tomography angiography (CCTA) has gained broad acceptance as a noninvasive anatomical imaging tool with ability of excluding coronary stenosis with strong negative predictive value. Atherosclerotic plaque lesions are independent predictors of cardiovascular outcomes in high risk patients with known coronary artery disease (CAD). Calcium detection is commonly expressed through the coronary artery calcium score (CACS), but further research is warranted to confirm the powerness of a CACS-only strategy in both diagnosis and prognosis assessment. Recent studies evidence how defined plaque composition characteristics effectively relate to the risk of plaque instabilization and the overall ischemic burden. Fractional flow reserve from CCTA (FFR-CT) has been demonstrated as a reliable method for noninvasive functional evaluation of coronary lesions severity, while the assessment of perfusion imaging under stress conditions is growing as a useful tool for assessment of myocardial ischemia. Moreover, specific applications in procedural planning of transcatheter valve substitution and follow-up of heart transplantation have gained recent importance. This review illustrates the incremental role of CCTA, which can potentially revolutionize the diagnosis and management pathway within the wide clinical spectrum of CCS.

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“…In the subset of patients with previous percutaneous coronary intervention, CT perfusion techniques are currently being investigated. The ADVANCE study is currently recruiting with the aim of reporting the diagnostic accuracy of this technique 67. Potentially, the greatest role of CACS and CTCA is in a primary preventionsetting.…”

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confidence: 99%

Latest Advances in Cardiac CT

et al. 2020

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Recent rapid technological advancements in cardiac CT have improved image quality and reduced radiation exposure to patients. Furthermore, key insights from large cohort trials have helped delineate cardiovascular disease risk as a function of overall coronary plaque burden and the morphological appearance of individual plaques. The advent of CT-derived fractional flow reserve promises to establish an anatomical and functional test within one modality. Recent data examining the short-term impact of CT-derived fractional flow reserve on downstream care and clinical outcomes have been published. In addition, machine learning is a concept that is being increasingly applied to diagnostic medicine. Over the coming decade, machine learning will begin to be integrated into cardiac CT, and will potentially make a tangible difference to how this modality evolves. The authors have performed an extensive literature review and comprehensive analysis of the recent advances in cardiac CT. They review how recent advances currently impact on clinical care and potential future directions for this imaging modality.

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Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study

Cited by 11 publications

References 28 publications

Cost-effectiveness of stress CTP versus CTA in detecting obstructive CAD or in-stent restenosis in stented patients

Cost-effectiveness of stress CTP versus CTA in detecting obstructive CAD or in-stent restenosis in stented patients

The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes

Latest Advances in Cardiac CT

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