Top cardiologists agree coronary CTA should be first-line tool in patients with stable CAD

The nation’s top cardiologists are recommending providers use coronary computed tomography angiography as a first-line tool to analyze patients with stable coronary artery disease.

The update is detailed in a September 2020 report published in the Journal of the American College of Cardiology and reflects the consensus of attendees at last year’s American College of Cardiology Summit on Technology Advances in Coronary Computed Tomography Angiography.

In patients with possible CAD, clinicians should adopt a CTA-first approach to detect coronary atherosclerosis instead of relying on myocardial perfusion abnormality, the report reads.

“In countries around the world, cardiac CT has been adopted as a first-line diagnostic test in patients with stable chest pain, and I have no doubt this strategy will be embraced in the U.S. as well if appropriate conditions can be established,” Society of Cardiovascular Computed Tomography President Koen Nieman, MD, PhD, said in a Tuesday statement.

The attendees offered up the following recommendations to move the field toward a CTA-first culture:

  • Use coronary CTA to examine patients with stable chest pain and low-to-intermediate pre-test likelihood of obstructive CAD.
  • Advocate for the technique with public and private payers in an effort to increase payments for coronary CTA.
  • Consider bundled payment options for cardiac exams.
  • Seek out expert and financial support to bolster the number of clinicians able to perform the exam and improve strategies to train providers in doing so.
  • Build an American College of Cardiology coronary CTA registry for chest pain that includes medical and economic variables for gauging the total cost of care associated with the exam.
  • Authorize education programs for cardiologists and primary care providers on when they should look toward coronary CTA compared to other approaches.

The recently published report includes evidence taken from multiple clinical trials, including early findings from ISCHEMIA, or the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches.