BlueCross BlueShield of Tennessee Medical Policy Manual

Coronary Computed Tomography Angiography (CCTA)

DESCRIPTION

Coronary computed tomography angiography (CCTA) is a noninvasive imaging test that requires the use of intravenously administered contrast material and high-resolution, high-speed computed tomography (CT) machinery to obtain detailed volumetric images of blood vessels.  It has been suggested that CCTA may help rule out coronary artery disease (CAD) and avoid invasive coronary angiography in individuals with low-to-intermediate pretest probabilities of CAD.

Different types of CT technology that can achieve high-speed CT imaging:

POLICY

See also: Computed Tomography to Detect Coronary Artery Calcification

MEDICAL APPROPRIATENESS

Pre-Test Probability of CAD by Age, Gender, and Symptoms

Age in Years

Gender

Typical/Definite Angina Pectoris

Atypical/Probable

Angina Pectoris

Non-anginal

Chest Pain

Asymptomatic

39 and younger

Men

Intermediate

Intermediate

Low

Very low

 

Women

Intermediate

Very low

Very Low

Very low

 

 

 

 

 

 

40-49

Men

High

Intermediate

Intermediate

Low

 

Women

Intermediate

Low

Very low

Very low

 

 

 

 

 

 

50-59

Men

High

Intermediate

Intermediate

Low

 

Women

Intermediate

Intermediate

Low

Very low

 

 

 

 

 

 

60 and over

Men

High

Intermediate

Intermediate

Low

 

Women

High

Intermediate

Intermediate

Low

 

 

 

 

 

 

High: Greater than 90% pre-test probability

Intermediate: Between 10% & 90% pre-test probability

Low: Between 5% & 10% pre-test probability

Very low: Less than 5% pre-test probability

Typical angina (definite): 1) Substernal chest pain or discomfort generally described as pressure, heaviness, burning or tightness that is 2) Generally brought on by exertion or emotional stress and 3) May radiate to the left arm or jaw.

Atypical angina (probable): Chest pain or discomfort (arm or jaw pain) that lacks one of the characteristics of definite or typical angina.

Non-anginal chest pain: Chest pain or discomfort that meets one or none of the typical angina characteristics.

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

Multiple large-scaled randomized controlled trials were performed to evaluate the role of cardiovascular computed tomography in patients presenting to the ED with acute chest pain. The results are shown in the ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria, which inspired the addition of CCTA as a diagnostic option in the American Heart Association scientific statement, particularly in the low-to-intermediate risk patient groups.

SOURCES

American College of Cardiology Foundation, Society of Cardiovascular Computed Tomography, American College of Radiology, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, North American Society for Cardiovascular Imaging, Society for Cardiovascular Angiography and Interventions, Society for Cardiovascular Magnetic Resonance. (November 2010). 2010 ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR appropriate use criteria for cardiac computed tomography. Retrieved September 8, 2016 from http://content.onlinejacc.org.

Andreini, D., Pontone, G., Pepi, M., Ballerini, G., Magini, A., Quaglia, C., et al. (2007). Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with dilated cardiomyopathy. Journal of American College of Cardiology, 49 (20), 2044-2050. Abstract retrieved October 30, 2017 from PubMed database.

Berbarie, R., Dockery, W., Johnson, K., Rosenthal, R., Stoler, R., & Schussler, J. (2006). Use of multislice computed tomographic coronary angiography for the diagnosis of anomalous coronary arteries. American Journal of Cardiology, 98 (3), 402-406. Abstract retrieved October 30, 2017 from PubMed database.

Budoff, M., Achenbach, S., Blumenthal, R., Carr, J., Goldin, J., Greenland, P., et al. (2006). Assessment of coronary artery disease by cardiac computed tomography. A scientific statement from the American Heart Association committee on cardiovascular imaging and intervention, council on cardiovascular radiology and intervention, and committee on cardiac imaging, council on clinical cardiology. Circulation, 114, 1761-1791.

Schlosser, T., Konorza, T., Hunoid, P., Kuhl, H., Schermund, A., & Barkhausen, J. (2004). Noninvasive visualization of coronary artery bypass grafts using 16-detector row computed tomography. Journal of American Cardiology, 44 (6), 1224-1229. (Level 4 evidence)

ORIGINAL EFFECTIVE DATE:  8/13/2005

MOST RECENT REVIEW DATE:  2/21/2018

ID_EC; BT

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