Prati Francesco
U.O.C. Cardiologia d'Urgenza, Azienda Ospedaliera San Giovanni-Addolorata, Roma.
G Ital Cardiol (Rome). 2019 Jul-Aug;20(7):409-416. doi: 10.1714/3190.31684.
Coronary computed tomography angiography (CCTA) is increasingly being used to assess patients with stable coronary artery disease (CAD) at low-intermediate risk because it has high sensitivity, specificity and negative predictive value for the detection of CAD. Technological advancements in the quantification and functional assessment of epicardial coronary stenosis by means of fractional flow reserve derived from computed tomography (FFRCT) have raised the possibility of expanding CCTA use to guide decision-making regarding revascularization strategies in CAD patients. Recent data have shown that initial diagnostic evaluation of coronary anatomy by CCTA vs standard of care in patients with suspected CAD is associated with lower rates of cardiac death or nonfatal myocardial infarction without long-term use of coronary angiography or coronary revascularization, suggesting a prognostic value of anatomic assessment in patients with suspected CAD. Good quality images are needed for reliable interpretations and results. Radiation exposure is still a concern.
冠状动脉计算机断层扫描血管造影（CCTA）越来越多地用于评估中低风险的稳定型冠状动脉疾病（CAD）患者，因为它在检测CAD方面具有高灵敏度、特异性和阴性预测值。通过计算机断层扫描衍生的血流储备分数（FFRCT）对心外膜冠状动脉狭窄进行量化和功能评估的技术进步，增加了将CCTA用于指导CAD患者血运重建策略决策的可能性。最近的数据表明，在疑似CAD患者中，通过CCTA对冠状动脉解剖结构进行初始诊断评估与标准治疗相比，在不长期使用冠状动脉造影或冠状动脉血运重建的情况下，心脏死亡或非致命性心肌梗死的发生率较低，这表明对疑似CAD患者进行解剖评估具有预后价值。需要高质量的图像才能获得可靠的解读和结果。辐射暴露仍然是一个问题。
