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64 Multislice CT in Coronary Heart Disease KCE Reports 82
9 CONCLUSIONS
9.1 TECHNICAL EFFICACY
64-SCT has shown to be able to image native coronary arteries with acceptable quality
in selected patient populations. Patients should be in a stable sinus rhythm, they shoud
be not too obese, they should be able to cooperate and they should have non-calcified
coronary arteries. The high burden of ionizing radiation remains a major obstacle. It is
currently not clear whether future technical improvements will lead to less radiation yet
preserve adequate diagnostic performance.
9.2 DIAGNOSTIC ACCURACY
The diagnostic accuracy of MSCT in CAD has been thoroughly tested predominantly in
patients at high-risk in whom it had already been decided to proceed to CCA, or in
whom the results of CCA were already available. In these populations the technique can
very well document normal coronary arteries and can adequately rule out obstructive
CAD. The test’s specificity is less than optimal, leading to false positives, especially in
lower prevalence populations.
The diagnostic performance of MSCT in real world clinical practice is not known.
9.3 DIAGNOSTIC THINKING
Only limited data are available supporting the use of MSCT with regard to its role
within patient care algorithms. The test performs best in patients with normal coronary
arteries, but it has yet to be ascertained whether these (normal) patients could not have
been identified otherwise in a safer and more cost-effective way.
9.4 THERAPEUTIC IMPACT
If MSCT performs in real world as good as in clinical trials, it might be a useful test to
exclude significant CAD. Documenting obstructive CAD by MSCT is of rather limited
value, because patient management and prognosis depend on the functional impact of
the coronary stenosis which cannot be assessed by MSCT alone. Moreover, in case
revascularisation is deemed appropriate, invasive CCA is inevitable.
9.5 PATIENT OUTCOMES
There is limited data on the prognostic value of MSCT and there is no evidence
whatsoever that the use of MSCT improves quality of life, prevents heart attacks or
saves lives.
9.6 COST-EFFECTIVENESS
A full economic evaluation of MSCT requires more data on the clinical effectiveness of
this diagnostic technique in preventing morbidity and mortality. It is yet impossible to
conclude whether MSCT is cost-effective compared to the standard diagnostic
protocols in low to intermediate risk patients.