Although studies have shown that using coronary CCTA first for evaluating CAD improves outcomes in patients with stable chest pain and lowers healthcare costs, most patients continue to be evaluated first with SPECT/CT, wrote a team led by Dr. Michael Poon of Lenox Hill Hospital - Northwell Health in New York City.
"In the United States, functional imaging is the most commonly used method to diagnose potentially obstructive coronary artery disease (CAD) in patients with stable chest pain," the group noted. "However, evidence from several contemporary randomized clinical trials may advocate a new paradigm of imaging for detecting coronary atherosclerosis, not only stenosis, in low- to moderate-risk patients."
The report reflects consensus of those who attended the ACC's Summit on Technology Advances in Coronary Computed Tomography Angiography in September of last year, according to the Society of Cardiovascular Computed Tomography (SCCT).
"The available evidence suggests that a CCTA-first strategy can provide important benefits to our patients, yet there are barriers to wider implementation, including inadequate payment, insufficient number of imagers (both cardiologists and radiologists) trained to interpret these tests, and a need for more education of referring physicians on when and how to utilize [CCTA] in patient care," said Dr. Ron Blankstein, SCCT immediate past president, in a statement released by the society.
The ACC's "to do list" for CCTA includes the following:
- Use CCTA first to evaluate patients with stable chest pain and low-to-intermediate probability of obstructive CAD.
- Advocate for increased payment for the exam with public and private payors.
- Investigate bundled payment options for cardiac testing.
- Increase the number of trained CCTA providers.
- Improve provider competency in performing CCTA.
- Establish an ACC CCTA registry for evaluating chest pain.
- Work to eliminate preapprovals for CCTA with commercial payors.
- Improve cardiologist and primary care physician education regarding when to use CCTA testing rather than other techniques.
The U.K. and the rest of Europe have changed their guidelines as a result of this evidence, according to the SCCT.
"In countries around the world, cardiac CT has been adopted as a first-line diagnostic test in patients with stable chest pain, and I have no doubt this strategy will be embraced in the U.S. as well if appropriate conditions can be established," said Dr. Koen Nieman, PhD, current SCCT president.
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