CT coronary angiographic evaluation of suspected anginal chest pain

Heart. 2016 Feb 15;102(4):263-8. doi: 10.1136/heartjnl-2015-307860. Epub 2015 Dec 8.


Non-invasive imaging plays a critical role in the assessment of patients presenting with suspected angina chest pain. However, wide variations in practice across Europe and North America highlight the lack of consensus in selecting the appropriate first-line test for the investigation of coronary artery disease (CAD). CT coronary angiography (CTCA) has a high negative predictive value for excluding the presence of CAD. As such, it serves as a potential 'gatekeeper' to downstream testing by reducing the rate of inappropriate invasive coronary angiography. Two recent large multicentre randomised control trials have provided insights into whether CTCA can be incorporated into chest pain care pathways to improve risk stratification of CAD. They demonstrate that using CTCA enhances diagnostic certainty and improves the targeting of appropriate invasive investigations and therapeutic interventions. Importantly, reductions in cardiac death and non-fatal myocardial infarction appear to be attained through the more appropriate use of preventative therapy and coronary revascularisation when guided by CTCA. With this increasing portfolio of evidence, CTCA should be considered the non-invasive investigation of choice in the evaluation of patients with suspected angina pectoris due to coronary heart disease.

Clinical trial number: NCT01149590, post-results.

Publication types

  • Review

MeSH terms

  • Angina Pectoris / diagnostic imaging*
  • Angina Pectoris / etiology
  • Angina Pectoris / therapy
  • Computed Tomography Angiography* / standards
  • Coronary Angiography / methods*
  • Coronary Angiography / standards
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / therapy
  • Coronary Vessels / diagnostic imaging*
  • Humans
  • Practice Guidelines as Topic
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results

Associated data

  • ClinicalTrials.gov/NCT01149590