Computed tomographic angiography (CTA)

Status: Decision completed

Policy context

Issues of efficacy, safety, and accuracy regarding use of computed tomographic angiography (CTA) imaging for screening or coronary artery disease. Concern that CTA may not identify accurately those patients with chest pain who will need catheter-based or surgical revascularization.

Primary Criteria Ranking

  • Safety = Low
  • Efficacy = High
  • Cost = High
Documents

Background

Heart disease is the leading cause of death in the United States and is a major cause of disability. Almost 700,000 people, 29% of US deaths, die of heart disease in the U.S. each year. Heart disease is a term that includes several more specific heart conditions. The most common heart disease in the United States is coronary artery disease (CAD), which can lead to heart attack. CAD is a narrowing of the coronary arteries that results in an insufficient supply of oxygen to the heart muscle and is a leading cause of death in the US and developed countries. CAD can affect one or more arteries and be either total or partial narrowing. CAD may be asymptomatic or lead to chest pain (angina), heart attack- myocardial infarction (MI), or death.

Coronary computed tomography angiography (CCTA) involves the use of CT scans and an injected dye to develop computer-aided, 3-dimensional images of the artery. Multi-slice CT scanners first received FDA approval in 1998, and their use (as well as level of precision) has evolved rapidly since then. CT angiography in general has proliferated into multiple indications, including head and neck vascular imaging (e.g., for occlusive carotid arterial disease), diagnosis of aortic dissection or thoracic aortic aneurysm, detection of pulmonary embolism, diagnosis of peripheral arterial disease, visualization of the abdominal vascular system (e.g., for abdominal aortic aneurysm), and detection of a variety of cardiac and cerebrovascular congenital abnormalities. 

CCTA has been suggested as an alternative to conventional coronary angiography (CA), which involves placement of a catheter and injection of contrast material into a large artery or vein, followed by 2-dimensional visualization using standard X-rays. The potential advantages of CCTA over conventional angiography include multiple-angle and multiple-plane visualization, improved visualization of soft tissues and adjacent anatomy, and a lower degree of invasiveness. Potential disadvantages of CCTA include increased radiation exposure, the possibility of incidental findings in adjacent anatomic structures, and the potential need for further testing.