Department of Medicine and Radiology, Weill Medical College of Cornell University, The New York Presbyterian Hospital, New York, New York, USA.
J Am Coll Cardiol. 2010 Mar 9;55(10):957-65. doi: 10.1016/j.jacc.2009.08.087.
In the past 5 years since the introduction of 64-detector row cardiac computed tomography angiography (CCTA), there has been an exponential growth in the quantity of scientific evidence to support the feasibility of its use in the clinical evaluation of individuals with suspected coronary artery disease (CAD). Since then, there has been considerable debate as to where CCTA precisely fits in the algorithm of evaluation of individuals with suspected CAD. Proponents of CCTA contend that the quality and scope of the available evidence to date support the replacement of conventional methods of CAD evaluation by CCTA, whereas critics assert that clinical use of CCTA is not yet adequately proven and should be restricted, if used at all. Coincident with the scientific debate underlying the clinical utility of CCTA, there has developed a perception by many that the rate of growth in cardiac imaging is disproportionately high and unsustainable. In this respect, all noninvasive imaging modalities and, in particular, more newly introduced ones, have undergone a higher level of scrutiny for demonstration of clinical and economic effectiveness. We herein describe the latest available published evidence supporting the potential clinical and cost efficiency of CCTA, drawing attention not only to the significance but also the limitations of such studies. These points may trigger discussion as to what future studies will be both necessary and feasible for determining the exact role of CCTA in the workup of patients with suspected CAD.
自引入 64 排心脏 CT 血管造影（CCTA）以来的过去 5 年中，支持将其用于疑似冠心病（CAD）患者临床评估的科学证据呈指数级增长。此后，关于 CCTA 在疑似 CAD 患者评估算法中的具体位置存在相当大的争议。CCTA 的支持者认为，迄今为止，可用证据的质量和范围支持用 CCTA 替代 CAD 评估的传统方法，而批评者则认为 CCTA 的临床应用尚未得到充分证明，应加以限制，如果使用的话。与 CCTA 的临床实用性相关的科学争论同时，许多人认为心脏成像的增长速度不成比例地高且不可持续。在这方面，所有非侵入性成像方式，特别是新引入的成像方式，都经历了更高水平的临床和经济有效性的审查。在此，我们描述了最新的可获得的支持 CCTA 潜在临床和成本效益的已发表证据，不仅强调了这些研究的意义，还强调了其局限性。这些观点可能会引发关于未来研究的讨论，这些研究对于确定 CCTA 在疑似 CAD 患者评估中的确切作用是必要且可行的。
