May 5, 2020
Over the past several weeks, I’ve had the opportunity to speak with many of you to understand how you are triaging and managing patients with suspected coronary artery disease in the COVID-19 era. One thing that has become abundantly clear is that as physicians, we won’t be returning to “business as usual.” As we consider how to best manage patients while increasing efficiency, and preserving resources such as PPE, I find the conversation returning to how a coronary CCTA-led pathway can play a critical role now and moving forward.
In light of this, I was highly encouraged to see the recent ESC guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. This publication summarizes global learnings about COVID-related illness and how it impacts cardiovascular health.
Within this discussion, it provides quite direct guidance to prioritize CCTA in CAD diagnosis during the pandemic: “CT angiography should be preferred to non-invasive functional testing during [the] COVID-19 pandemic” (Table 13).
Key excerpts from the document explain the reasoning behind this clear directive:
Additionally, the ISCHEMIA trial’s influence on clinical decision making is clear within the discussion of Management and Treatment Pathways as a conservative pathway is prioritized for many patients.
In addition to the ESC guidance, a new guidance from SCAI/ ACC/ ACEP and an update from SCCT indicate that CCTA may be appropriate for helping physicians triage patients in the emergency room setting. In the SCAI/ACC/ACEP recommendation on AMI patients, the recommendation is to utilize CCTA if the echocardiography and ECG results are divergent. Similarly, the updated SCCT guidance recommends that utilizing CCTA in the ER setting may result in a meaningful change to patient management or outcomes.
While these publications are meant to provide guidance during this pandemic period, it is clear that some of the changes being recommended now will prove to be beneficial for patients and providers even after this pandemic subsides.
With clinicians now using more technology and digital solutions to gain efficiency, it seems reasonable to believe that the movement to CCTA for CAD diagnosis will be a change that stays, as it uniquely provides a combination of diagnostic confidence, prognostic insights, patient-provider safety, and increasing availability of CT-derived lesion-specific physiology.