Indications for CT Coronary Angiography

Cardiac Society Australia and New Zealand (2010)

  1. The strength of MDCT is to rule out significant coronary artery disease (CAD) in a low-intermediate risk population with symptoms. This has been demonstrated in multi-centre trials.
  2. Investigation of equivocal or uninterpretable stress tests
  3. Evaluation of suspected coronary anomalies / complex congenital heart disease
  4. Evaluation of new onset heart failure / cardiomyopathy of unknown aetiology
  5. Mapping of coronary vasculature including internal mammary arteries before repeat CABG
  6. Evaluation of left bundle branch block; f. Excluding significant CAD before non-coronary cardiac surgery

CTCA is inappropriateon patients who have known significant CAD or a high pre-test probability of CAD (conventional catheter angiography is more appropriate).

NICE guidelines (2020) 

(National Institute for Health Care and Excellence – United Kingdom)

CT coronary angiography if: clinical assessment indicates typical or atypical angina, or clinical assessment indicates non-anginal chest pain but 12-lead resting ECG has been done and indicates ST-T changes or Q waves.

Non-invasive functional testing Offer non-invasive functional imaging for myocardial ischaemia if 64-slice (or above) CT coronary angiography has shown coronary artery disease of uncertain functional significance or is non-diagnostic. When offering non-invasive functional imaging for myocardial ischaemia use: MPS with SPECT or stress echocardiography or first-pass contrast-enhanced magnetic resonance perfusion or MRI for stress-induced wall motion abnormalities.