van den Hoogen Inge J, van Rosendael Alexander R, Lin Fay Y, Bax Jeroen J, Shaw Leslee J, Min James K
Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Curr Cardiovasc Imaging Rep. 2019 Jun;12(6). doi: 10.1007/s12410-019-9497-1. Epub 2019 May 14.
Coronary computed tomography angiography (CCTA) is the optimal non-invasive test to rule out coronary artery disease (CAD). Decisions to perform coronary revascularization have traditionally been based upon ischemia testing. This review summarizes the latest observations and trials evaluating the suitability of CCTA to select patients for invasive coronary angiography (ICA) and subsequent revascularization.
Recent data shows that beyond stenosis, whole-heart quantification and characterization of coronary atherosclerotic plaque improves the estimation of myocardial ischemia. This comprehensive evaluation of the coronary artery tree has greater diagnostic accuracy for invasive fractional flow reserve (FFR) than conventional stress tests. Further, clinical trials have demonstrated that the performance of CCTA in patients with a clinical indication for ICA results in more effective patient care and significantly lower costs.
Besides the excellent ability to rule out CAD, recent data shows that quantification and characterization of the coronary artery tree results in high accuracy for ischemia and that CCTA-guided care to select patients for ICA and revascularization is effective. Trials evaluating revascularization based on CCTA findings may be needed.
冠状动脉计算机断层扫描血管造影（CCTA）是排除冠状动脉疾病（CAD）的最佳无创检查。传统上，进行冠状动脉血运重建的决策基于缺血检测。本综述总结了评估CCTA用于选择进行有创冠状动脉造影（ICA）及后续血运重建患者的适用性的最新观察结果和试验。
近期数据表明，除狭窄外，对冠状动脉粥样硬化斑块进行全心定量和特征分析可改善对心肌缺血的评估。对冠状动脉树的这种综合评估在诊断有创血流储备分数（FFR）方面比传统负荷试验具有更高的准确性。此外，临床试验表明，对有ICA临床指征的患者进行CCTA检查可实现更有效的患者护理，并显著降低成本。
除了具有出色的排除CAD能力外，近期数据表明，对冠状动脉树进行定量和特征分析对缺血具有高度准确性，并且CCTA指导下选择进行ICA和血运重建的患者护理是有效的。可能需要进行基于CCTA结果评估血运重建的试验。
