biondi-zoccai: ct & coronary angiography [email protected] – metcardio.org why coronary...
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Why coronary CT is inferior Why coronary CT is inferior to invasive coronary to invasive coronary
angiographyangiography
Giuseppe Biondi ZoccaiUniversity of Turin, Turin, Italy
Convegno A.R.C.A: S. Vittoria d'Alba
24 October 2009 – 12:40-13:00
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SCOPE OF THE SCOPE OF THE PROBLEMPROBLEM
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LEARNING GOALSLEARNING GOALS
What CT angiography ISWhat CT coronary angiography IS NOT
ProsCons
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LEARNING GOALSLEARNING GOALS
What CT angiography ISWhat CT coronary angiography IS NOT
ProsCons
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WHAT CT CORONARY WHAT CT CORONARY ANGIOGRAPHY ISANGIOGRAPHY IS
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WHAT CT CORONARY WHAT CT CORONARY ANGIOGRAPHY ISANGIOGRAPHY IS
Computed tomography coronary angiography is a radiographic modality exploiting X-ray exposure and contrast media administration to non-invasively image coronary vessels
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WHAT CT CORONARY WHAT CT CORONARY ANGIOGRAPHY ISANGIOGRAPHY IS
Computed tomography coronary angiography is a radiographic modality exploiting X-ray exposure and contrast media administration to non-invasively image coronary vessels
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WHAT CT CORONARY WHAT CT CORONARY ANGIOGRAPHY ISANGIOGRAPHY IS
Computed tomography coronary angiography is a radiographic modality exploiting X-ray exposure and contrast media administration to non-invasively image coronary vessels
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LEARNING GOALSLEARNING GOALS
What CT angiography ISWhat CT coronary angiography IS NOT
ProsCons
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WHAT CT CORONARY WHAT CT CORONARY ANGIOGRAPHY IS NOTANGIOGRAPHY IS NOT
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WHAT CT CORONARY WHAT CT CORONARY ANGIOGRAPHY IS NOTANGIOGRAPHY IS NOT
Per-patient sensitivity
Hamon et al, JACC 2006
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LEARNING GOALSLEARNING GOALS
What CT angiography ISWhat CT coronary angiography IS NOT
ProsCons
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CONSCONSNot feasible if:
◦Allergy to CM◦Can’t hold breath◦Extensive coronary calcifications◦Morbidly obese◦Pacemaker◦Severe arrhythmia◦Severe hepatorenal insufficiency◦Small vessel disease◦Thick-strut stents
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CONSCONS
Pugliese et al, Radiology 2009
Increasing experience with coronary CT angiography improved the diagnostic performance of inexperienced physicians. However, acquiring expertise in coronary CT angiography was slow and may take more than 1 year.Mean evaluation time for trainees was 20 minutes at baseline and 13 minutes after 1 year. Mean evaluation time of the expert physicians was 10 minutes. However, it took an additional 5 minutes to achieve consensus.
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CONSCONS
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CONSCONS
Coles et al, JACC 2006
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CONSCONS
Einstein et al, JAMA 2007
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TAKE HOME MESSAGESTAKE HOME MESSAGES
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TAKE HOME MESSAGESTAKE HOME MESSAGESCT coronary angiography has higher costs
and risks (i.e. radiation and contrast) in comparison to other non-invasive tests
It also has inferior diagnostic performance in comparison to invasive coronary angiography
Thus, CT coronary angiography remains a promising diagnostic modality whose clinical use should be highly individualized, as shown by this recent example…
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rgThank you for your attentionThank you for your attention
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