SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography.
SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography.
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DOI：
10.1016/j.jcct.2020.11.001
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发表时间：
2021-05
影响因子：
5.4
通讯作者：
Hecht HS
中科院分区：
文献类型：
--
作者：
Narula J;Chandrashekhar Y;Ahmadi A;Abbara S;Berman DS;Blankstein R;Leipsic J;Newby D;Nicol ED;Nieman K;Shaw L;Villines TC;Williams M;Hecht HS
自 SCCT 发布最新主要指南以来，心脏计算机断层扫描 (CT) 发生了迅速变化。 1 虽然技术取得了重大进步，但最令人欣慰的是，为心脏 CT 在心脏病诊断、预测和调节治疗（医学和介入）中的应用建立了强有力的证据基础。在过去广泛的临床接受之前，这种知识库的系统开发还没有成为任何其他成像方式的惯例。毫不奇怪，主要指南机构已开始比以前更明确地认可心脏 CT 的纳入，有些指南（例如英国的 NICE 指南）2 甚至将其列为一线地位。虽然 CTA 已被证明对于预测风险非常有效，可以排除稳定胸痛患者的严重冠状动脉疾病 (CAD)，并且对于识别显着冠状动脉狭窄具有较高的敏感性，但它的特异性和阳性预测准确性稍差，导致增值 CT 血管造影 (CTA) 策略的发展，例如 CT 衍生的血流储备分数 (CT-FFR) 和 CT 灌注 (CTP)；自上次指南以来，这些已经进入临床领域，更重要的是，产生了大量显示出重要临床实用性的科学数据。最后，常规临床实践中经常出现的一些问题缺乏基于可靠试验的证据，经过深思熟虑的专家意见可能有助于临床医生在日常实践中做出适当的决定。因此，很明显，需要更新最新数据的学术概要，以弥合自 SCCT 指南文件上次迭代以来的知识差距。这份 SCCT 共识声明总结了当前证据，更新了之前的建议，解决了在多种不同心脏情况下使用 CTA 的关键问题，并以明确建议的形式汇集了文献库。急性冠状动脉综合征的 CTA 将在单独的文件中介绍。表 1 和图 1 总结了专家共识的建议。
Cardiac computed tomography (CT) has changed rapidly since the last major guideline from SCCT. 1 While there have been significant advances in technology, the most gratifying part has been the development of a robust evidence base for the use of cardiac CT in diagnoses of heart disease, prognostication and modulating therapy (both medical and interventional). Such a systematic development of knowledge base has not been the usual practice for any other imaging modality before widespread clinical acceptance in the past. It is no surprise that major guideline bodies have started to endorse incorporation of cardiac CT more definitively than before, and some, like the NICE guidelines in the UK, 2 have even given it first line status. While CTA has been shown to be very good for prognosticating risk, excluding significant coronary artery disease (CAD) in stable patients with chest pain and has high sensitivity for the identification of significant coronary stenoses, it is somewhat less robust in specificity and positive predictive accuracy, leading to the development of value added CT angiography (CTA) strategies like fractional flow reserve derived from CT (CT-FFR) and CT perfusion (CTP); these have arrived into the clinical arena since the last guidelines and, more importantly, have produced a large volume of scientific data showing significant clinical utility. Finally, some questions that often arise in regular clinical practice lack robust trial based evidence and a considered expert opinion might help the clinician make appropriate decisions in everyday practice. It is thus clear that an updated scholarly compendium of recent data is needed to bridge the knowledge gap since the last iteration of the SCCT guideline documents. This SCCT consensus statement summarizes current evidence, updates previous recommendations, addresses key questions regarding the use of CTA in multiple different cardiac scenarios and brings together the collective corpus of literature in the form of definitive recommendations. CTA in acute coronary syndromes will be presented in a separate document. The Expert Consensus recommendations are summarized in Table 1 and Fig. 1.
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