Have clinical trials shown an advantage to using coronary CTA in place of catheter angiograms or nuclear stress tests?
Early coronary CTA studies performed on 4- and 16-slice MDCT scanners raised doubt as to the accuracy of coronary CTA. Newer studies performed on 40- and 64-slice MDCT scanners, using catheter angiography as the reference standard, show coronary CTA to have a sensitivity of 96% to 99% for stenoses of greater than 50% on a per-patient level, with a specificity of 88% to 93%. Other studies have compared the use of coronary CTA in low-risk chest pain patients in the emergency department in place of serial cardiac enzymes and nuclear stress testing. These studies show quicker discharge, lower cost, and no missed cardiac events (for follow-up periods of 1 year) for the coronary CTA group, and support the use of coronary CTA as accurate and cost-effective in low-risk chest pain patients. In addition, coronary CTA provides a large amount of data that are mostly unobtainable by catheter angiography and nuclear stress testing, such as plaque composition, extent of vessel remodeling, extracardiac findings, aberrant coronary artery course, and numerous other pathologies.