April 5, 2011 by dailybolusoflr
As Coronary CT Angiography becomes a more frequently used and available test, it is important to know in what situations and populations this test is appropriately used to replace a standard stress test.
The 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography endorses the use of CCTA for symptomatic patients:
· For low risk patients, CCTA can RULE out significant disease
· For intermediate risk patients, CCTA can EXCLUDE patients with obstructive disease (stenosis which is > 50%)
NOTE: CCTA is ANATOMIC imaging…which is best used as a RULE OUT test. This is opposed to FUNCTIONAL imaging (such as a myocardial perfusion test) which can determine whether or not the symptoms are likely to be related to disease which is found. Functional tests can be used as RULE In tests. CCTA may be able to tell you if there is stenosis, but as an anatomic imaging test, it is unable to tell you whether or not that stenosis is leading to compromise.
Due to the high dose of radition associated with it, this document does NOT advocate use of the “triple rule out” or CT imaging of the coronary vessels, aorta and pulmonary vessels for PE in ED patients.
Am Coll Cardiol, 2010; 55:2663-2699
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions