International practice patterns of coronary artery calcium scanning prior to coronary CT angiography star

Coronary CT angiography (CCTA) acquisition guidelines defer the performance of coronary artery calcium (CAC) scanning prior to CCTA to provider and site preferences. 1 Abbara S. Blanke P. Maroules C.D. et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the society of cardiovascular computed tomography guidelines committee: endorsed by the north American society for cardiovascular imaging (NASCI). J Cardiovasc Comput Tomogr. 2016; 10: 435-449 Abstract Full Text Full Text PDF PubMed Scopus (533) Google Scholar According to large-scale registry data, CAC scanning is frequently performed immediately prior to CCTA. 2 Villines T.C. Hulten E.A. Shaw L.J. et al. Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: an International Multicenter) registry. J Am Coll Cardiol. 2011; 58: 2533-2540 Crossref PubMed Scopus (297) Google Scholar Reasons often cited in support of performing CAC prior to CCTA include that the presence and severity of coronary calcifications may help to optimize CCTA acquisition parameters (e.g., peak tube potential, tube current, and/or type of electrocardiographic gating or triggering) to ensure good image quality, that the visualization of extensive CAC may help determine the diagnostic feasibility and utility of CCTA, and that CAC conveys important prognostic information. Those opposed to the routine CAC testing prior to CCTA note that its performance exposes the patient to additional radiation, with CAC significantly increasing the dose proportionally in the current era of lower CCTA radiation imaging, or that the prognostic findings from CAC are not additive to CCTA. An evaluation of the performance and perceived utility of CAC scanning in patients undergoing CCTA has not been performed.