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Authors say benefits include lower risk and cost, plus information on extent of coronary atherosclerosis

A “computed tomography (CT)-first” strategy may be the best way to determine if stable chest pain patients need revascularization, according to a study presented at the American College of Cardiology Cardiovascular Summit 2024, which took place Feb. 1 to 3 in Washington, D.C.

William E. Downey, M.D., from Atrium Health Sanger Heart & Vascular Institute in Charlotte, North Carolina, and colleagues assessed whether a “CT-first” strategy versus functional testing or no testing is associated with higher rates of subsequent revascularization after invasive coronary angiography (ICA) in clinical practice. The analysis included 786 consecutive patients who had no prior diagnosis of coronary artery disease and were referred for elective ICA to evaluate chest pain.

The researchers found that the pre-ICA testing strategies included no testing in 44 percent, stress echo in 3 percent, stress myocardial perfusion imaging in 15 percent, stress magnetic resonance imaging in 2 percent, and coronary CT angiography in 36 percent. Subsequent revascularization occurred in 62 percent using the “CT-first” strategy versus 34 percent for other modalities.

“While care must be individualized, for patients with unknown or unestablished coronary artery disease, the transition to a ‘CT-first’ strategy should be a high priority for cardiovascular care providers,” senior author Markus D. Scherer, M.D., also from the Sanger Heart & Vascular Institute, said in a statement. “The noninvasive approach has a lower risk and cost than a diagnostic heart catheterization and, for the CT approach — but not stress testing — provides information on the absence, presence, and extent of coronary atherosclerosis and whether or not there are high risk plaques as well as vessel blockages, which helps streamline patient management and risk reduction.”

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