cardiac computed tomography (CCT)

Cardiac Computed Tomography Writing Group; Allen J. Taylor, MD, FACC, FAHA, Chair^*;Manuel Cerqueira, MD, FACC, FASNC; John McB. Hodgson, MD, FACC, FSCAI;Daniel Mark, MD, MPH, FACC, FAHA^*; James Min, MD, FACC; Patrick O'Gara, MD, FACC, FAHA^||;Geoffrey D. Rubin, MD, FSCBTMR^¶,#

^* Official American College of Cardiology Foundation Representative.
 Official American Society of Nuclear Cardiology Representative.
 Official Society for Cardiovascular Angiography and Interventions Representative.
 Official Society of Cardiovascular Computed Tomography Representative.
^|| Official American Heart Association Representative.
^¶ Official American College of Radiology Representative.
^# Official North American Society for Cardiovascular Imaging Representative.
Christopher M. Kramer, MD, FACC, FAHA; Michael J. Wolk, MD, MACC
Moderator, Cardiac Computed Tomography Technical Panel
Chair, Appropriate Use Criteria Task Force


Key Words: AHA Scientific Statements • coronary artery bypass graft surgery • coronary artery disease • coronary heart disease • coronary calcium score • computed tomography • computed tomographic angiography • electrocardiogram • heart failure • estimated metabolic equivalents of exercise • myocardial infarction • percutaneous coronary intervention • perioperative evaluation

	Abstract

The American College of Cardiology Foundation, along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonanceappropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria.¹
The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use.
In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research./.../