CCTA also similarly predicted revascularization within 30 days as invasive angiography (ROC area 0.84 versus 0.82 for CCTA and quantitative coronary angiography, respectively) [30]. The CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) showed that patients with nonobstructive and obstructive CAD have incrementally higher rates of mortality, whereas the absence of atherosclerosis is associated with a very favorable prognosis [83]. Presence of extensive nonobstructive CAD have higher rates of adverse cardiovascular events than patients with less extensive but obstructive disease (14.5% versus 13.6%), underscoring the prognostic value of plaque burden only available with CCTA [83]. Presence of high-risk plaque features has been shown as an independent predictor of major acute coronary events in patients with nonobstructive CAD [84-87]. In patients who underwent previous coronary stenting, CCTA can identify in-stent re-stenosis. Andreini et al [88] have demonstrated specificity, PPV, NPV, and diagnostic accuracy for in-stent re-stenosis detection were 91%, 99%, 60% and 91%, respectively. In a meta-analysis conducted by Kumbhani et al [89], the overall sensitivity, specificity, PPV, and NPV for assessable stents were 91%, 91%, 68%, and 98%. No relevant data currently exists on using CCTA for initial evaluation of patients with suspected in-stent re-stenosis with chronic chest pain and a high probability of CAD with known IHD. FFR-CT FFR-CT allows for the determination of lesion-specific ischemia associated with a coronary arterial narrowing. FFR-CT is performed in conjunction with CCTA [33,34]. FFR-CT is available for native coronary arteries and not available in patients who underwent coronary artery bypass grafts, and it is not available for assessment of stented coronary arteries [33,34]. There is no current data on use of FFR-CT in selected groups of patients with known CAD.
Chronic Chest Pain High Probability of Coronary Artery Disease PCAs. CCTA also similarly predicted revascularization within 30 days as invasive angiography (ROC area 0.84 versus 0.82 for CCTA and quantitative coronary angiography, respectively) [30]. The CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) showed that patients with nonobstructive and obstructive CAD have incrementally higher rates of mortality, whereas the absence of atherosclerosis is associated with a very favorable prognosis [83]. Presence of extensive nonobstructive CAD have higher rates of adverse cardiovascular events than patients with less extensive but obstructive disease (14.5% versus 13.6%), underscoring the prognostic value of plaque burden only available with CCTA [83]. Presence of high-risk plaque features has been shown as an independent predictor of major acute coronary events in patients with nonobstructive CAD [84-87]. In patients who underwent previous coronary stenting, CCTA can identify in-stent re-stenosis. Andreini et al [88] have demonstrated specificity, PPV, NPV, and diagnostic accuracy for in-stent re-stenosis detection were 91%, 99%, 60% and 91%, respectively. In a meta-analysis conducted by Kumbhani et al [89], the overall sensitivity, specificity, PPV, and NPV for assessable stents were 91%, 91%, 68%, and 98%. No relevant data currently exists on using CCTA for initial evaluation of patients with suspected in-stent re-stenosis with chronic chest pain and a high probability of CAD with known IHD. FFR-CT FFR-CT allows for the determination of lesion-specific ischemia associated with a coronary arterial narrowing. FFR-CT is performed in conjunction with CCTA [33,34]. FFR-CT is available for native coronary arteries and not available in patients who underwent coronary artery bypass grafts, and it is not available for assessment of stented coronary arteries [33,34]. There is no current data on use of FFR-CT in selected groups of patients with known CAD.