Chest pain CT scan

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Aisha Adigun, B.Sc., M.D.[3]

Overview

Coronary CT angiography (CCTA) can be helpful to diagnose the extent and severity of nonobstructive and obstructive CAD, as well as high-risk features of atherosclerotic plaque (positive remodeling, low attenuation plaque). Fractional flow reserve with CT (FFR-CT) provides additional information about ischemia related to lesion. Dosimetry is low for CCTA, with effective doses for most patients in the 3 to 5 mSv range.

Coronary CT angiography (CCTA) can be helpful to diagnose the extent and severity of nonobstructive and obstructive CAD, as well as high-risk features of atherosclerotic plaque (positive remodeling, low attenuation plaque).
Fractional flow reserve with CT (FFR-CT) provides additional information about an estimation of ischemia related to lesion. Radiation dosimetry is low, as 3 to 5 mSv range.

	Favored use of Coronary CT Angiography (CCTA)	Favored used of stress imaging
Aim	Determining obstructive or non-obstructice CAD	Managing ischemia
Likelihood of obstructive CAD	Age<65 years	Age≥ 65 years
Previous test	Inconclusive prior functional study	Inconclusive prior CCTA
Other indications	Anomalous coronary arteries, evaluation of aorta, pulmonary arteries	Evaluation of scar or microvascular dysfunction by PET or stress CMR

Pretest likelihood of CAD (coronary artery disease)
Low risk= Risk stratification of ASCVD (atherosclerotic cardiovascular disease), optional CAC (coronary artery calcium score)
Intermediate-high risk, younger patient <65 years, suspected less obstructive CAD = Favored Coronary CT Angiography
Intermediate-high risk, older patient≥ 65 years, suspected more obstructive CAD= Favored Stress Testing

The above table adopted from 2021 AHA/ACC/ASE Guideline^[1]

↑ Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O’Connor RE, Ross MA, Shaw LJ (November 2021). “2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”. Circulation. 144 (22): e368–e454. doi:10.1161/CIR.0000000000001029. PMID 34709879 Check |pmid= value (help).