SCCT 2020 Highlights: The Shift in Prioritization of CCTA

“Change is the law of life. And those who look only to the past or present are certain to miss the future.” – John F. Kennedy

Some advances have seemed imminent for years, but for one reason or another, they have continually remained just out of reach. The prioritization of coronary CTA in mainstream clinical care has long been an example of this.

However, during the 15th Annual Scientific Meeting of the Society of Cardiovascular Computed Tomography (SCCT), which took place virtually late last month, much of the evidence and many indicators highlighted how the clinical role of coronary CTA is rapidly changing and expanding.

One year ago, the European Society of Cardiology (ESC) gave coronary CTA a Class I indication in updated guidelines, a decision that relied heavily on the 2015 PROMISE Trial findings of equivalency between coronary CTA and other non-invasive cardiac tests. The SCOT-HEART trial and the ISCHEMIA Trial further emphasized the significant clinical value of coronary CTA in decision making for stable chest pain patients. And now, as providers are looking for ways to provide high quality, efficient, and safe care to their patients during the current COVID-19 pandemic, we see how coronary CTA is being prioritized above other alternative diagnostic tests.

As the faculty of SCCT 2020 offered a comprehensive overview of these transitions within cardiovascular care, there were particular statements which stood out:

• How significant is the impact of ISCHEMIA on the use of coronary CTA? "Huge!" according to Dr. David Maron, lead author of the ISCHEMIA trial findings. He also emphasized the ability of CCTA to stratify long-term risk in a manner beyond other non-invasive cardiac tests.
• Can FFR_CT be efficiently integrated?: "It is really ready to be integrated," argued Dr. Jeroen Bax, the past-president of the ESC. While discussing the ease of use, convenient turnaround time, and strong clinical outcome data, he indicated that for the "daily business where patients are waiting and we need to move," FFR_CT is the right choice.
• Using FFR_CT in clinical practice: "The majority of rejected studies are non- analyzable because of motion artifacts, and therefore patient preparation is the key with adequate beta blockers," instructed Dr. Kavitha Chinnaiyan, a member of the SCCT Executive Committee. She also reported on the "significant decrease in turnaround times," that they have seen in daily clinical practice.
• Moving forward with coronary CTA: “In the COVID era, where we are trying to be as efficient as possible, it's even more important to always ask: what is the best test to address the question so we can rapidly and efficiently provide the right answers?” remarked Dr. Ron Blankstein, the President of the SCCT.

At SCCT 2020, we saw that as the current pandemic has collided with expanding clinical data and real-world experience around coronary CTA, alignment is increasingly shifting toward coronary CTA. Previous delays in the adoption of coronary CTA are being overcome as clinicians and administrators search for pathways and tools that will allow them to continue delivering the care patients deserve while also minimizing contact, PPE usage, and potentially unnecessary procedures.

As Dr. Jonathon Leipsic, a past president of the SCCT, stated, “This pandemic and the expectations of our patients and the Hippocratic oath really behoove us to ignore historical pathways and really focus on what makes most sense for our patients.”

This is an extraordinary time of change, and that came through clearly during the SCCT 2020 sessions.

All quotes are from recorded sessions of SCCT 2020, presented on July 17-18, 2020.