Associate Professor of Radiology BUMS, Tehran, Iran
In stable angina, it is critical to determine the presence and extent of obstructive or non- obstructive coronary atherosclerotic disease, the mechanism of myocardial ischemia and ruling out other DDXs, in order to managing symptoms and preventing major adverse cardiovascular events (MACE) including MI or death from cardiovascular disease (CVD) by initiating optimal treatment. These patients were routinely evaluated with a variety of noninvasive tests such as electrocardiography (ECG), exercise treadmill test (ETT), stress echocardiography, single photon emission computed tomography (SPECT), and stress radionuclide scintigraphy or stress cardiac magnetic resonance imaging (CMR).
These functional tests assist in diagnosing CAD and provide prognostic information by detecting inducible myocardial ischemia as a marker of the underlying CAD, But in all cases cannot completely help in the diagnosis of obstructive CAD, coronary artery anomalies or other DDXs such as PTE or dissection, so direct visualization by a noninvasive imaging modality such as CCTA seems to be the best choice and CCTA can changes diagnoses, improves diagnostic certainty and changes management, leads to more appropriate use of invasive coronary angiography, and reduces fatal myocardial infarction. In low- to intermediate-risk patients with acute chest pain, CCTA is not only safe, but potentially allows for reduced costs and LOS, and the diagnosis of non-coronary causes of acute, life-threatening chest pain that may otherwise be missed. The role of CCTA in higher-risk patients (such as those with confirmed NSTEMI) is evolving and it may provide a safe means of identifying patients without obstructive disease, for whom medical therapy may be sufficient. CCTA can also aid in plaque characterization, which can facilitate personalized therapeutic interventions and distinguish culprit from non- culprit lesions, or even non-atheromatous causes of ACS. Keywords: CAD, CCTA, stable angina, ACS