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On the Inappropriateness of Noninvasive Multidetector Computed Tomography Coronary Angiography to Trigger Coronary Revascularization
JACC - Journal of the American College of Cardiology: Cardiovascular Interventions, 06/18/09

Sarno G et al. - Similar to Coronary Angiography, anatomical assessment of coronary stenosis severity by MDCTA does not reliably predict its functional significance.

Exclusive Author Commentary
Dr. William Wijns, 06/29/09

Since Coronary CT provides tridimensional information as well as imaging of positive remodeling, we hypothesized that CT would be more accurate than conventional angiography to evaluate stenosis significance. This hypothesis was not verified. Limited spatial resolution of CT remains an issue, but above all, a combined anatomical and functional evaluation is required for proper patient management, at least with stable presentations of the disease. The conventional approach combines non invasive functional evaluation with invasive evaluation of anatomy by angiography. With the emergence of both non invasive anatomical imaging using CT and invasive functional evaluation using pressure-derived fractional flow reserve, many additional opportunities for comprehensive assessment became available. In my opinion, there should be no room left for revascularisation decisions in stable patients in the absence of functional testing.

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