November 17th, 2023

What Impact is CCTA having on Coronary Interventions?

Over the past 4-5 years, there has been a rapid increase in the studies and articles on cardiac CT angiography (CCTA). For 15 years prior to this, many of the early articles primarily focused on the use of CT for coronary calcium scoring for early identification of patients at risk for coronary artery disease and cardiac events along with the benefits of preventative therapies. More recently, with the introduction of artificial intelligence (AI) tools, CCTA is making its way to the top of the list of the tools being used by cardiologists for prognosis and treatment of patients with coronary artery disease. CCTA w/ fractional flow reserve (FFRCT) is now supporting interventional cardiologists in pre-procedure planning 1 thus increasing revascularizations rates among patients referred for elective ICA.1₁

A consensus document that was published by the Society of Cardiac Computed Tomography and North American Society of Cardiovascular Imaging states that CCTA provides a wealth of clinically meaning information beyond anatomic stenosis, including the presence and absence of nonobstructive atherosclerosis and high-risk plague features being precursors for incident of coronary artery disease.₂

The article, “Pre-Procedural Planning of Coronary Revascularization by Cardiac Computed Tomography,” published in the Journal of Cardiovascular Computed Tomography (JCCT), states that CCTA combined with fractional flow reserve (CT-FFR) or stress CT myocardial perfusion imaging (CT-MPI) can overcome the limitations of two-dimensional invasive coronary angiography (ICA) by providing a comprehensive anatomical and physiological roadmap for coronary revascularization. Additionally, the consensus document published by the Society of Cardiac Computed Tomography, co-published with Eurointervention, explains that CCT may emerge in the field of interventional cardiology as no longer “a mere diagnostic tool,” as it was when first introduced into clinical practice more than 15 years ago.

According to the writing group, led by Daniele Andreini, MD, PhD, FSCCT of Centro Cardiologico Monzino in Milan, Italy, 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. With the additional information used to assess the coronary artery anatomy, the number of patients referred to the catheterization lab is expected to increase over the next decade.₁

Andreini and his co-authors explain that, with its 3-dimensional nature and physiological assessment, CCTA is the only non-invasive imaging modality to assess Syntax Score and Syntax Score II, which enable the Heart Team to select the mode of revascularization (PCI or CABG) for patients with complex disease based on long-term mortality.

When these tools are utilized for diagnosis and treatment planning, patients’ care is tailored more specifically for early medical or invasive interventions. An abstract presented at SCCT meeting in July 2023 by Wesley T. O’Neal, MD, et al. on data collected on patients from Cone Health Heart and Vascular Center, showed the benefits for diagnosis and treatment from implementation of CCTA/FFRCT program. A robust program increased revascularization to invasive coronary angiography (ICA) rates among patients referred for elective ICA, thus improving catheterization laboratory utilization. The abstract shown in Table 1, shows that while the number of elective revascularization procedures remained similar during the study period, 2018-2022, the ratio of revascularization to ICA increased by 21% for the same period.

The emerging articles show that the use of CCTA/FFRCT has a positive impact of appropriate patient selection for ICA and revascularization. Additionally, it allows for pre-planning of procedures and patient care, optimizing cardiac catheterization laboratory resources, workflows, and patient care.

Cardiac CT programs are changing the way that cardiologists diagnose and treat patients with potential for cardiac events. A robust CCTA program, combined with the tools provided by HeartFlow, Cleerly, Elucid Vivo, and Caristo, has substantial impact on our ability to appropriately impact patient care earlier and impact outcomes while supporting efficient use of catheterization laboratory and provider resources. A CCTA program that focuses on efficient workflows, optimal patient prep, along with necessary AI, will improve efficiencies for ICA programs.

Is your CCTA program providing maximum benefits for your cardiologists?

References

Andreini, et al. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. Journal of Cardiovascular Computed Tomography. Published November 2022>
J. Shaw, et al. Society of Cardiovascular Computed Tomography / North American Society of Cardiovascular Imaging – Expert Consensus Document on Coronary CT Imaging of Atherosclerotic Plaque. Journal of Cardiovascular Computed Tomography. Published March 2021
O’Neal, et al. Impact of CCTA/FFRCT on Referrals for Invasive Coronary Angiography and Revascularization in a Community-based Health System. Presented Society of Cardiovascular Computed Tomography Meeting. July 2023
https://scct.org/news/news.asp?id=615188&hhSearchTerms=%22CCTA+and+%2b+and+PCI%22

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New Cardiac CT site opened in the Mountain Region of Colorado!

Another successful initiation of cardiac CT program happened last week. In Colorado mountain region where patients frequently must be air transferred to the nearest cath lab, a CCTA can significantly improve care of local patients and visitors by rapid triaging of acute patients and avoiding many unnecessary transfers to Denver.

This program will serve residents by facilitating earlier diagnostic workups for chest pain and keeping patients local, decreasing the amount of travel required to care. This cardiac CT program is also equipped with some of the newest AI programs that supplement anatomical CT images with plaque analysis and CT FFR information, providing more information to support physicians with treatment planning.

How can cardiac CT support your program with early diagnosis and keeping patient care local?

March 25th, 2024

Cracking the Code: How Coronary Calcium Scans Unlock Heart Health Secrets

Medical technology advancements have paved the way for early detection and the prevention of heart-related issues. One such groundbreaking diagnostic tool is the coronary calcium scan. This non-invasive imaging procedure plays a crucial role in assessing the risk of heart disease by detecting the presence of calcified plaque in the coronary arteries.

We spoke to Katarina Nelson, MD, FACC, a non-invasive cardiologist specializing in general cardiology, preventive care, women and heart disease, and a wide range of cardiovascular imaging. She joined CommonSpirit Health at the St. Anthony Hospital in Summit in August 2022.

February is American Hearth Month

We asked Dr. Nelson to share a few heart health statistics with us to recognize American Heart Month. She told us, “Cardiovascular disease is the leading cause of death in the U.S. for both men and women. There are 400,000 deaths a year among women and 386,000 deaths among men a year in the U.S. Coronary Artery Disease (CAD) alone is the cause of 175,000 deaths a year. This makes CAD the most common cause of mortality among adults in the United States.

“While common, it is preventable,” Dr. Nelson emphasized, reminding us that “CAD and its risk factors can be screened, identified, and treated early.”

Understanding Coronary Calcium Scans

A coronary calcium scan is a specialized imaging test using computed tomography (CT) technology to create detailed images of the coronary arteries. The primary purpose of this scan is to identify and quantify the amount of calcium deposits in the coronary arteries, which are indicative of atherosclerosis or plaque buildup.

Calcium deposits in the coronary arteries are a key marker of atherosclerosis, a condition characterized by the hardening and narrowing of the arteries. As plaque accumulates over time, it can restrict blood flow to the heart, leading to cardiovascular issues, including heart attacks. “The calcium score, also known as the Agatson score or coronary calcium CT scan, is a special computerized tomography (CT) scan of the heart,” Dr. Nelson said. “It looks for calcium deposits in the heart arteries.

“Coronary calcium scan results can help determine the risk of heart attacks or strokes, and the results from the scan can guide therapies for coronary artery disease.”

How Can It Save Your Life?

The information obtained from a coronary calcium scan is invaluable in assessing an individual’s risk of developing heart disease. By identifying the presence and extent of calcified plaque, healthcare professionals can gauge the severity of atherosclerosis and tailor a preventive strategy accordingly.

Early detection through a coronary calcium scan allows for timely intervention, enabling individuals to make lifestyle changes, initiate medications, or undergo medical procedures to prevent the progression of heart disease. This proactive approach significantly reduces the risk of heart attacks and other cardiovascular events.

How Can You Get a Coronary Calcium Scan?

Getting a coronary calcium scan involves consulting with a health care provider, who will assess your risk factors for heart disease. Common risk factors include age, family history, smoking, high blood pressure, and high cholesterol levels. Your provider may recommend a coronary calcium scan to evaluate your cardiovascular health based on the evaluation.

The procedure itself is quick, usually taking 15 minutes or less, and painless. During the scan, you lie on a table that slides into the CT scanner. The scanner captures detailed images of your heart, and the results are analyzed to determine the presence and extent of calcium deposits.

Popularity of Coronary Calcium Scans

The popularity of coronary calcium scans has steadily increased as awareness of preventive cardiology grows. Many recognize the importance of early detection and intervention to safeguard their heart health. Health care providers also incorporate these scans into routine screenings for individuals at risk of heart disease.

The availability and recommendation of coronary calcium scans may vary based on geographical location, health care infrastructure, and individual risk profiles. However, the rising prominence of preventive health care is contributing to the widespread adoption of these scans in many regions.

Who Benefits Most?

“The calcium score is best for asymptomatic patients with no known coronary artery disease, who are over 45 years old with a strong family history of early coronary artery disease, borderline or elevated lipids to guide treatment decisions for cholesterol management and potential further testing.”

Dr. Nelson

It is not, she warned, the best course for those at high risk of heart attacks or who have previous heart conditions.

“It is a screening tool for coronary artery disease equivalent to a mammogram for breast cancer or colonoscopy for colon cancer,” Dr. Nelson said. She described a recent 46-year-old active patient with a significant family history of premature coronary artery disease. Telling us his risk factors, she said, “His father died of myocardial infarction at age 42, and his first cousin underwent bypass surgery at age 40.” The scan showed a high calcium score, which led to further workup that showed critical stenosis or blockage in one of the main coronary arteries. “He was treated with coronary artery stenting to open the pathway and to prevent heart attacks and sudden cardiac death.”

Next Steps

The decision to undergo a coronary calcium scan should be in consultation with a health care provider. Before recommending the scan, they will assess your overall health, medical history, and risk factors. Additionally, guidelines may vary, and health care professionals will consider individual circumstances when making recommendations.

In the quest for optimal heart health, coronary calcium scans emerge as a powerful tool for early detection and prevention of heart disease. By providing crucial insights into the presence of calcified plaque in the coronary arteries, these scans empower individuals and health care professionals to take proactive measures to mitigate cardiovascular risks. As awareness grows, the coronary calcium scan will play a pivotal role in preventive cardiology, ultimately saving lives through early intervention and personalized care.