Computed tomography coronary angiography (CTCA) is a non-invasive diagnostic modality
that provides a comprehensive anatomical assessment of the coronary arteries and coronary
atherosclerosis, including plaque burden, composition and morphology. The past decade
has witnessed an increase in the role of CTCA for evaluating patients with both stable
and acute chest pain, and recent international guidelines have provided increasing
support for a first line CTCA diagnostic strategy in select patients. CTCA offers
some advantages over current functional tests in the detection of obstructive and
non-obstructive coronary artery disease, as well as for ruling out obstructive coronary
artery disease. Recent randomised trials have also shown that CTCA improves prognostication
and guides the use of guideline-directed preventive therapies, leading to improved
clinical outcomes. CTCA technology advances such as fractional flow reserve, plaque
quantification and perivascular fat inflammation potentially allow for more personalised
risk assessment and targeted therapies. Further studies evaluating demand, supply,
and cost-effectiveness of CTCA for evaluating chest pain are required in Australia.
This discussion paper revisits the evidence supporting the use of CTCA, provides an
overview of its implications and limitations, and considers its potential role for
chest pain evaluation pathways in Australia.
Keywords
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Article info
Publication history
Published online: January 05, 2023
Accepted:
December 6,
2022
Received in revised form:
October 7,
2022
Received:
June 13,
2022
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.