ACC CardiaCast CCTA in Stable Chest Pain: Applying Guideline Recommendations
Oct 26, 2025
Dr. Ron Blankstein is an Associate Director of the Cardiovascular Imaging Program, sharing insights on chest pain guidelines and the role of CCTA. Dr. Kelley Branch, a professor of cardiology, discusses cutting-edge imaging technologies. They explore how CCTA fits into clinical pathways for evaluating stable chest pain and emphasize the importance of guidelines in selecting appropriate testing modalities. The conversation highlights advances in cardiac CT, including photon-counting technology, and suggests future directions for the evaluation of chest pain.
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Guideline Focus And Evidence Strength
- The 2021 Chest Pain Guideline is the first U.S. guideline focused on the symptom of chest pain and its equivalents.
- Coronary CTA has the highest level of evidence (LOE A) among modalities for diagnosing coronary disease in patients without known CAD.
Use CTA For Non‑Low Pretest Probability
- Use coronary CTA for patients who are not low pretest probability, i.e., intermediate-to-high pretest probability of obstructive disease.
- Ensure CTA is available, performed with expertise, and the patient can tolerate breath-hold and IV contrast for good image quality.
Match Test Choice To Local Expertise
- Choose tests based on local availability and trusted expertise rather than theoretical superiority.
- Prefer modalities your center can perform well, such as StressEcho, SPECT, PET, MRI, or coronary CTA depending on resources.