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CT coronary angiography will have an increasingly more important role in evaluating coronary artery disease in the near future, researchers suggest.

CT coronary angiography will have an increasingly more important role in evaluating coronary artery disease in the near future, researchers suggest.

This approach has the advantage of offering information on the presence and extent of atherosclerosis within vessel walls - not available with invasive angiography - and may also be more cost-effective.

A systematic review analysed data from 40 studies, including more than 2,400 people, comparing 64-slice CT angiography with invasive angiography in the assessment of coronary artery disease [1].

The UK study found that pooled sensitivity of 64-slice CT in patient-based detection was 99 per cent, with a specificity of 89 per cent. In segment based detection these values were 90 per cent and 97 per cent, respectively.

The researchers said that, for many patients, "The diagnosis of coronary artery disease remains uncertain following clinical assessment and simple non-invasive testing.... It seems likely that multi-slice CT may have an increased role in this setting."

Multi-slice CT might also have a role, they said, in specified groups of patients. For example, patients with a history of CABG in whom invasive angiography might be more difficult, and patients scheduled for surgery for non-coronary cardiac conditions.

Meanwhile, US researchers have assessed the cost-effectiveness for using coronary angiography in the triage of patients with low-risk acute chest pain, using a microsimulation model [2].

The study compared a standard-of-care pathway – based on invasive coronary angiography – with one based on 64-slice CT coronary angiography.

The CT coronary angiography pathway increased total healthcare costs in men by $200, whereas in women, these costs were reduced by $380.

The researchers summated: "Compared with the SOC, the incremental cost-effectiveness ratio for CT coronary angiography management was $6400 per QALY in men; in women, the strategy was cost-saving."

One of the study authors, Dr Joseph A. Ladapo, MD, PhD of Beth Israel Deaconess Medical Center in Boston, said it was likely that CT coronary angiography would be used to assess low-risk patients with chest pain in the near future as it was cheaper and more efficient.

He added: "The CT technology is advancing in terms of its resolution, and physicians are developing methods to further reduce the radiation dose to which patients are exposed."

[1] 64-slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis
Heart 2008; Online First

[2] Cost-effectiveness of coronary MDCT in the triage of patients with acute chest pain
AJR 2008; 191:455-463