Coronary heart disease CT
Coronary heart disease Microchapters
Coronary heart disease CT On the Web
American Roentgen Ray Society Images of Coronary heart disease CT
Coronary calcium scores
The Agatston scores are:
- 0 No identifiable disease
- 1 to 99 Mild disease
- 100 to 399 Moderate disease
- ≥400 Severe disease
In asymptomatic patients
Clinical practice guidelines
- "the current evidence is insufficient to assess the balance of benefits and harms of using the ABI, hsCRP level, or CAC score in risk assessment for CVD in asymptomatic adults to prevent CVD events"
The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol concluded:
- "In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL to 189 mg/dL (≥1.8–4.9 mmol/L), at a 10-year ASCVD risk of ≥7.5% to 19.9%, if a decision about statin therapy is uncertain, consider measuring CAC."
- Among patients without an event, the ASCVD risk alone with less than 7.5% in 82.3% and >= 7.5% in 17.7%. With the CAC:
- The predicted risk was < 7.5% in 76.2%. Thus, the true negative rate dropped by 6%.
- The predicted risk was >= 7.5% in 23.8%. Thus the false positive rate rose by 6%
- Among patients with an event, the ASCVD risk alone was over 7.5% in 42.8%. With the CAC:
- The predicted risk was < 7.5% in 60.6%. Thus the true positive rate rose by 18%
Overall, the net classification improvement was 12% (18% - 6%) and the accuracy dropped due to the drop in specificity in a population with low prevalence.
A preliminary randomized controlled trial of CAC suggests benefit on LDL levels.
Coronary computed tomographic angiography (CCTA)
The role of coronary computed tomographic angiography (CCTA) versus functional testing is not clear:
- The SCOT-HEART trial in 2015 did not find clear statistical evidence of benefit although there was a trend towards less cardiac outcomes among patients who received CCTA
- The PROMISE trial in 2015 did not find benefit
- A meta-analysis in 2018 that included the SCOT-HEART and PROMISE trials found no benefit
- Subsequent publication of longer term follow-up of the SCOT-HEART trial found cardiac benefit The benefit may be in part due to "During follow-up, patients assigned to CTA were more likely than patients assigned to standard care alone to have commenced preventive therapies (19.4% [402 patients] vs. 14.7% [305 patients]; odds ratio, 1.40; 95% confidence interval [CI], 1.19 to 1.65)." This is larger than the difference in clinical outcomes, "2.3% [48 patients] in the CTA group vs. 3.9% [81 patients] in the standard-care group; hazard ratio, 0.59; 95% CI, 0.41 to 0.84; P=0.004."
Noninvasive fractional flow reserve
Estimation of fractional flow reserve using coronary computed tomographic angiography (FFRCT) did not reduce cardiac events over one year.
Epidural fatpad thickness
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- SCOT-HEART investigators (2015). "CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial". Lancet. 385 (9985): 2383–91. doi:10.1016/S0140-6736(15)60291-4. PMID 25788230.
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