Society of Cardiovascular Computed Tomography

Five Things Physicians and Patients Should Question

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1

Don’t use coronary artery calcium scoring for patients with known coronary artery disease (including stents and bypass grafts).

Coronary artery calcium scoring is used for evaluation of individuals without known coronary artery disease and offers limited incremental prognostic value for individuals with known coronary artery disease, such as those with stents and bypass grafts.

2

Don’t order coronary artery calcium scoring for preoperative evaluation for any surgery, irrespective of patient risk.

No evidence exists to support the diagnostic or prognostic potential of coronary artery calcium scoring in individuals in the preoperative setting. This practice may add costs and confound professional guideline-based evaluations.

3

Don’t order coronary artery calcium scoring for screening purposes on low risk asymptomatic individuals except for those with a family history of premature coronary artery disease.

Net reclassification of risk by coronary artery calcium scoring, when added to clinical risk scoring, is least effective in low risk individuals.

4

Don’t routinely order coronary computed tomography angiography for screening asymptomatic individuals.

Coronary computed tomography angiography findings of coronary artery disease stenosis severity rarely offer incremental discrimination over coronary artery calcium scoring in asymptomatic individuals.

5

Don’t use coronary computed tomography angiography in high risk* emergency department patients presenting with acute chest pain.

To date, randomized controlled trials evaluating use of coronary computed tomography angiography for individuals presenting with acute chest pain in the emergency department have been limited to low or low-intermediate risk individuals.

* Risk defined by the Thrombolysis In Myocardial Infarction (TIMI) risk score for unstable angina/acute coronary syndromes.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

The Society of Cardiovascular Computed Tomography (SCCT) is the professional society devoted exclusively to cardiovascular computed tomography (CCT), representing physicians, scientists and technologists advocating for research, education and clinical excellence in the use of CCT. With an expanding global membership, it is acknowledged and recognized as the representative and advocate for research, education, and clinical excellence in the use of cardiovascular computed tomography. SCCT’s mission includes fostering optimal clinical effectiveness of CCT through professional education, establishment of standards for quality assurance and professional training, and development of evidence-based guidelines for its use to enhance patient care and improve the quality of cardiovascular medical practice. SCCT also serves as an advocate for cardiovascular CT in all interactions with the health care industry, medical policy development and reimbursement organizations.

Learn more at: www.scct.org.

How this list was created: The Society of Cardiovascular Computed Tomography (SCCT) formed a committee panel made up of expert members of its existing Guidelines Committee and Publications and Statements Committee that would be dedicated to recommending between five and 10 questions that should be considered when ordering Coronary CT angiography and coronary artery calcium scoring. The panel reviewed and referred to SCCT’s existing and published guidelines, appropriate use criteria and support statements. Once questions were chosen, the list was referred to the SCCT Board of Directors, which then reviewed the draft list, offered feedback and narrowed the questions down to the five most important consideration points through online voting. The draft was returned to the working group panel, which fleshed out the chosen recommendations and cited its supporting evidence from currently published literature. The SCCT’s Board of Directors and Executive Board each then reviewed the final five items and implemented another round of edits before voting for final review and approval.

SCCT’s bylaws and its disclosure and conflict of interest policy can be found at www.scct.org.

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