Contemporary Chest Pain Evaluation: The Australian Case for Cardiac CT

Abdul Rahman Ihdayhid; Nick S R Lan; Gemma A Figtree; Sanjay Patel; Clare Arnott; Christian Hamilton-Craig; Peter J Psaltis; Jonathon Leipsic; Timothy Fairbairn; Sudhir Wahi; Graham S Hillis; James M Rankin; Girish Dwivedi; Stephen J Nicholls

doi:10.1016/j.hlc.2022.12.003

Contemporary Chest Pain Evaluation: The Australian Case for Cardiac CT

Heart Lung Circ. 2023 Mar;32(3):297-306. doi: 10.1016/j.hlc.2022.12.003. Epub 2023 Jan 5.

Authors

Affiliations

¹ Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Curtin University, Perth, WA, Australia. Electronic address: [email protected].
² Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia.
³ Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia.
⁴ Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁵ Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Cardiovascular Division, The George Institute for Global Health, Sydney, NSW, Australia.
⁶ The Centre for Advanced Imaging, The University of Queensland, Brisbane, Qld, Australia.
⁷ Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia.
⁸ University of British Columbia, St Paul's Hospital, Vancouver, Canada.
⁹ Liverpool Heart and Chest Hospital, Liverpool, UK.
¹⁰ Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia.
¹¹ Department of Cardiology and University of Western Australia, Royal Perth Hospital, Perth, WA, Australia.
¹² Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia.
¹³ Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Vic, Australia.

PMID: 36610819
DOI: 10.1016/j.hlc.2022.12.003

Abstract

Computed tomography coronary angiography (CTCA) is a non-invasive diagnostic modality that provides a comprehensive anatomical assessment of the coronary arteries and coronary atherosclerosis, including plaque burden, composition and morphology. The past decade has witnessed an increase in the role of CTCA for evaluating patients with both stable and acute chest pain, and recent international guidelines have provided increasing support for a first line CTCA diagnostic strategy in select patients. CTCA offers some advantages over current functional tests in the detection of obstructive and non-obstructive coronary artery disease, as well as for ruling out obstructive coronary artery disease. Recent randomised trials have also shown that CTCA improves prognostication and guides the use of guideline-directed preventive therapies, leading to improved clinical outcomes. CTCA technology advances such as fractional flow reserve, plaque quantification and perivascular fat inflammation potentially allow for more personalised risk assessment and targeted therapies. Further studies evaluating demand, supply, and cost-effectiveness of CTCA for evaluating chest pain are required in Australia. This discussion paper revisits the evidence supporting the use of CTCA, provides an overview of its implications and limitations, and considers its potential role for chest pain evaluation pathways in Australia.

Keywords: Cardiovascular diseases; Chest pain; Coronary artery disease; Tomography; X-ray computed.

MeSH terms

Australia / epidemiology
Chest Pain / diagnostic imaging
Chest Pain / etiology
Coronary Angiography / methods
Coronary Artery Disease* / diagnostic imaging
Coronary Artery Disease* / therapy
Fractional Flow Reserve, Myocardial*
Humans
Predictive Value of Tests
Tomography, X-Ray Computed / methods