Guidelines updated for patient selection for cardiac computed tomography
MKSAP Quiz: confusion, fever, and flank pain
A new report provides new and expanded criteria to help clinicians optimally select patients who could benefit from cardiac computed tomography (CCT) and inform payers about appropriate clinical scenarios for its use.
The new criteria, issued by the American College of Cardiology and the Society of Cardiovascular Computed Tomography, assessed the appropriateness of CCT imaging for 93 different clinical scenarios—an increase from 39 in the 2006 report—scoring each to determine if the use of CCT imaging was appropriate, inappropriate or uncertain for a given situation.
According to the new guidelines, CCT angiography is considered appropriate for diagnosis and risk assessment in patients with symptoms of possible heart disease who have a low to intermediate risk of a heart problem, or uncertainty regarding their diagnosis after other tests are performed. Testing in high-risk patients, routine repeat testing and general screening in patients with no symptoms or other clinical scenarios are generally not considered appropriate.
The original appropriate use criteria for CCT were issued in 2006 when this technology was still relatively new. The updated criteria also broadened the number of patients and applications of non-contrast CT for calcium scanning. According to the appropriateness ratings, calcium scanning is considered appropriate among patients without heart symptoms who have an intermediate risk of heart disease or selected patients with low risk (particularly women or younger men) who have a family history of heart problems.
The guidelines' clinical scenarios include acute and chronic chest pain, testing in symptomatic and asymptomatic patients, heart failure, preoperative risk assessment before both cardiac and noncardiac surgery, and evaluation of cardiac structure and function, among others. Of the clinical scenarios evaluated, cardiac CT was deemed appropriate in 37%, and the remainder were considered either inappropriate uses or uncertain.
Groups endorsing the criteria include the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Society for Cardiovascular Angiography and Interventions, the American College of Radiology and the Society for Cardiovascular Magnetic Resonance.
Full text of this report will be published in the November 23, 2010, issue of the Journal of the American College of Cardiology and available on the organization's Web site. It will also be co-published in Circulation and the Journal of Cardiovascular Computed Tomography.