Volume 3, Supplement 2 , Pages S99-S108, November 2009
Efficacy of coronary CT angiography: Where we are, where we are going, and where we want to be
Abstract
Over the decade since its earliest introduction, coronary CT angiography has spread rapidly, despite the fact that its validation base is smaller than that of alternative imaging examinations. Consensus statements have issued a call for improvement of coronary CT angiography's knowledge base. This article reviews recent progress in validating the efficacy of coronary CT angiography in the detection of coronary artery disease, with a focus on clinical decision making, management, and outcomes. We discuss the rationale for comparative effectiveness research and a framework for assessment of levels of efficacy. Comparison is made with radionuclide myocardial perfusion imaging, which serves as a model noninvasive examination. The potential roles of coronary CT angiography in screening, early triage, and as a gatekeeper for catheterization are discussed. Although few randomized controlled trials have been performed to date, we review the pivotal publications and mention ongoing and future efforts. Cardiovascular event rates provide the basis for estimating the success of potential study designs. The rigorous validation of coronary CT angiography may serve as a model for other noninvasive diagnostics.
Keywords: Clinical management, Clinical trial design, Coronary computed tomography angiography, Cost-effectiveness, Diagnostic accuracy, Efficacy, Evidence-based practice, Outcomes, Prognostic value, Randomized controlled trials
To access this article, please choose from the options below
Conflict of interest: The authors report no conflicts of interest.
The research presented here was funded in part by a grant from the American Heart Association Founders Affiliate Clinical Research Program to J.M.L.
PII: S1934-5925(09)00514-0
doi:10.1016/j.jcct.2009.10.008
© 2009 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Volume 3, Supplement 2 , Pages S99-S108, November 2009
