1. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org Why coronary CT is inferior to invasive coronary angiography Giuseppe Biondi Zoccai University of Turin, Turin, Italy gbiondizoccai@gmail.com Convegno A.R.C.A: S. Vittoria d'Alba 24 October 2009 – 12:40-13:00

2. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org SCOPE OF THE PROBLEM

3. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org LEARNING GOALS What CT angiography IS What CT coronary angiography IS NOT Pros Cons

4. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org LEARNING GOALS What CT angiography IS What CT coronary angiography IS NOT Pros Cons

5. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org WHAT CT CORONARY ANGIOGRAPHY IS

6. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org WHAT CT CORONARY ANGIOGRAPHY IS Computed tomography coronary angiography is a radiographic modality exploiting X-ray exposure and contrast media administration to non-invasively image coronary vessels

7. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org WHAT CT CORONARY ANGIOGRAPHY IS Computed tomography coronary angiography is a radiographic modality exploiting X-ray exposure and contrast media administration to non-invasively image coronary vessels

8. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org WHAT CT CORONARY ANGIOGRAPHY IS Computed tomography coronary angiography is a radiographic modality exploiting X-ray exposure and contrast media administration to non-invasively image coronary vessels

9. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org LEARNING GOALS What CT angiography IS What CT coronary angiography IS NOT Pros Cons

10. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org WHAT CT CORONARY ANGIOGRAPHY IS NOT

11. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org WHAT CT CORONARY ANGIOGRAPHY IS NOT Per-patient sensitivity Hamon et al, JACC 2006

12. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org LEARNING GOALS What CT angiography IS What CT coronary angiography IS NOT Pros Cons

13. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org CONS Not feasible if: ◦ Allergy to CM ◦ Can’t hold breath ◦ Extensive coronary calcifications ◦ Morbidly obese ◦ Pacemaker ◦ Severe arrhythmia ◦ Severe hepatorenal insufficiency ◦ Small vessel disease ◦ Thick-strut stents

14. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org CONS Pugliese et al, Radiology 2009 Increasing experience with coronary CT angiography improved the diagnostic performance of inexperienced physicians. However, acquiring expertise in coronary CT angiography was slow and may take more than 1 year. Mean evaluation time for trainees was 20 minutes at baseline and 13 minutes after 1 year. Mean evaluation time of the expert physicians was 10 minutes. However, it took an additional 5 minutes to achieve consensus.

15. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org CONS

16. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org CONS Coles et al, JACC 2006

17. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org CONS Einstein et al, JAMA 2007

18. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org TAKE HOME MESSAGES

19. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org TAKE HOME MESSAGES CT coronary angiography has higher costs and risks (i.e. radiation and contrast) in comparison to other non-invasive tests It also has inferior diagnostic performance in comparison to invasive coronary angiography Thus, CT coronary angiography remains a promising diagnostic modality whose clinical use should be highly individualized, as shown by this recent example…

20. Biondi-Zoccai: CT & coronary angiography gbiondizoccai@gmail.com – metcardio.org Thank you for your attention For any correspondence: gbiondizoccai@gmail.com For these and further slides on these topics feel free to visit the metcardio.org website: http://www.metcardio.org/slides.html gbiondizoccai@gmail.com http://www.metcardio.org/slides.html gbiondizoccai@gmail.com http://www.metcardio.org/slides.html