title: Finding the Gatekeeper to the Cardiac Catheterization Laboratory: Coronary CT Angiography or Stress Testing?
abstract: Functional capacity is a robust predictor of clinical outcomes, and stress testing is used in current practice paradigms to guide referral to invasive coronary angiography. However, invasive coronary angiography is driven by ongoing symptoms, as well as risk of adverse outcomes. The limitations of current functional testing-based paradigms might be avoided by using coronary computed tomographic angiography (CCTA) for exclusion of obstructive coronary artery disease. The growth of CCTA has been supported by comparative prognostic evidence with CCTA and functional testing, as well as radiation dose reduction. Use of CCTA for physiological evaluation of coronary lesion-specific ischemia may facilitate evaluation of moderate stenoses, designation of the culprit lesion, and prediction of benefit from revascularization. The potential of CCTA to serve as an effective gatekeeper to invasive coronary angiography will depend, in part, on the adoption of these new developments, as well as definition of the benefit of detecting high-risk plaque for guiding the management of selected patients.
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address: Tom.Marwick@utas.edu.au.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
authors.affiliation: Dalio Institute of Cardiovascular Imaging at New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York.
authors.forename: Iksung
authors.initials: I
authors.lastname: Cho
authors.affiliation: Dalio Institute of Cardiovascular Imaging at New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York.
authors.forename: Bríain
authors.initials: B
authors.lastname: Ó Hartaigh
authors.affiliation: Dalio Institute of Cardiovascular Imaging at New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000208:Acute Disease; D006328:Cardiac Catheterization; D002637:Chest Pain / Q000175:diagnosis*; D017023:Coronary Angiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D007753:Laboratories; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D014057:Tomography, X-Ray Computed
keywords: angina; atherosclerotic; cardiac catheterization; chest pain; coronary artery disease; coronary computed tomography; plaque