CT angiography is increasingly offering itself as an alternative to invasive coronary angiography. Study data indicate good relevance for CHD diagnosis in stable, symptomatic patients. In this indication, CT angiography shows a very high sensitivity and is therefore more suitable for reliably ruling out coronary heart disease.
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When diagnosed with coronary heart disease (CHD), you may face a very different scenario, says Prim, MD. Gert Kluck is head of the Department of Internal Medicine at the Bruck an der Mur location of LKH Hochsteiermark. These range from asymptomatic high-risk patients with symptomatic CHD to acute coronary syndromes.1 In these situations, imaging can play different roles. As Kluck explains, recommendations for this vary greatly among different guidelines. Several studies have examined the use of computed tomography (CT) in this clinical continuum. Consequently, evidence for or against the use of CT in various stages of CHD is now available.
In asymptomatic patients, there is usually no indication to clarify using imaging, Gluck says. Calcium score alone can play a specific role in risk stratification. From a Ca score above 100 Agatston units (AU) associated with moderate CHD, prophylactic aspirin intake is indicated. According to the ESC guidelines, the Ca score has a IIb recommendation (can be considered). Under no circumstances should the Ca score be used to diagnose CHD, Kluck emphasizes.
