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Why coronary CT is inferior to invasive coronary angiography

Why coronary CT is inferior to invasive coronary angiography. Giuseppe Biondi Zoccai University of Turin, Turin, Italy gbiondizoccai@gmail.com. Convegno A.R.C.A: S. Vittoria d'Alba 24 October 2009 – 12:40-13:00. SCOPE OF THE PROBLEM. LEARNING GOALS. What CT angiography IS

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Why coronary CT is inferior to invasive coronary angiography

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  1. Why coronary CT is inferior to invasive coronary angiography Giuseppe Biondi Zoccai University of Turin, Turin, Italy gbiondizoccai@gmail.com Convegno A.R.C.A: S. Vittoria d'Alba 24 October 2009 – 12:40-13:00

  2. SCOPE OF THE PROBLEM

  3. LEARNING GOALS • What CT angiography IS • What CT coronary angiography IS NOT • Pros • Cons

  4. LEARNING GOALS • What CT angiography IS • What CT coronary angiography IS NOT • Pros • Cons

  5. WHAT CT CORONARY ANGIOGRAPHY IS

  6. WHAT CT CORONARY ANGIOGRAPHY IS • Computed tomography coronary angiography is a radiographic modality exploiting X-ray exposure and contrast media administration to non-invasively image coronary vessels

  7. WHAT CT CORONARY ANGIOGRAPHY IS • Computed tomography coronary angiography is a radiographic modality exploiting X-ray exposure and contrast media administration to non-invasively image coronary vessels

  8. WHAT CT CORONARY ANGIOGRAPHY IS • Computed tomography coronary angiography is a radiographic modality exploiting X-ray exposure and contrast media administration to non-invasively image coronary vessels

  9. LEARNING GOALS • What CT angiography IS • What CT coronary angiography IS NOT • Pros • Cons

  10. WHAT CT CORONARY ANGIOGRAPHY IS NOT

  11. WHAT CT CORONARY ANGIOGRAPHY IS NOT Per-patient sensitivity Hamon et al, JACC 2006

  12. LEARNING GOALS • What CT angiography IS • What CT coronary angiography IS NOT • Pros • Cons

  13. CONS • Not 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

  14. CONS 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. Pugliese et al, Radiology 2009

  15. CONS

  16. CONS Coles et al, JACC 2006

  17. CONS Einstein et al, JAMA 2007

  18. TAKE HOME MESSAGES

  19. TAKE HOME MESSAGES • CT 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…

  20. ThankyouforyourattentionForanycorrespondence: gbiondizoccai@gmail.comForthese and furtherslides on thesetopicsfeel free tovisit the metcardio.org website:http://www.metcardio.org/slides.html

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