SCCT Expert Consensus Document Evaluates CCTA for Preprocedural Planning of Myocardial Revascularization Interventions

August 25, 2022—The Society of Cardiovascular Computed Tomography (SCCT) announced the publication of an expert consensus document that describes coronary CT angiography (CCTA) as an effective tool for interventional cardiologists to prepare and optimize coronary procedures. The document states that CCTA combined with fractional flow reserve (CT-FFR) or stress CT myocardial perfusion imaging (CT-MPI) can provide a comprehensive anatomic and physiologic roadmap for coronary revascularization.

The expert consensus document, “Preprocedural Planning of Coronary Revascularization by Cardiac Computed Tomography,” by Daniele Andreini, MD, et al was copublished in Journal of Cardiovascular Computed Tomography and EuroIntervention.

According to SCCT, the expert consensus document explains that CCTA may emerge in the field of interventional cardiology as more than “a mere diagnostic tool,” as it was when it was first introduced into clinical practice more than 15 years ago.

The writing group, led by Dr. Andreini, who is from Centro Cardiologico Monzino in Milan, Italy, explained that the potential value of CCTA to plan and guide interventional procedures lies in the wide information it can provide, including its accuracy for plaque and calcium characterization.

They noted that CCTA, with its three-dimensional nature and physiological assessment, is the only noninvasive imaging modality to assess Syntax Score and Syntax Score II, which enable the Heart Team to select the mode of revascularization (either percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery) for patients with complex disease based on long-term mortality.

Additionally, CCTA may help in identifying anatomical characteristics of chronic total occlusions (CTOs) that are associated with increased complexity of CTO PCI. Previous to PCI procedures, CCTA has the potential to be used to overcome some limitations of conventional invasive coronary angiography, including vessel foreshortening and difficulties in selecting optimal projections, with particular importance in bifurcation and ostial lesion, advised the writing group, as reported in SCCT press release.