[Current guidelines for chronic coronary syndrome : Role of computed tomography-coronary angiography and pretest probability for coronary artery disease].

Abstract

Due to its high sensitivity and high negative predictive value, computed tomography angiography of the coronary arteries (CCTA) has proven to be particularly useful for ruling out obstructive coronary artery disease (CAD) in cases of suspected chronic coronary syndrome (CCS), which is why CCTA will also be included in the care of patients with statutory health insurance in Germany according to the G-BA decision of January 24, 2024. The value of CCTA is clearly confirmed in the current guidelines of the European Society of Cardiology (ESC) and the national care guideline from August 2024. However, good results from CCTA can only be achieved-in addition to appropriate qualifications of those performing the test and the necessary technical requirements-if the right patients are included, namely those with a low intermediate pretest probability for the presence of obstructive CAD. For this purpose, the pretest probability (PTP) for the presence of obstructive CAD must be determined before the indication is established. As it is not yet clear which method should be used for this purpose, this overview presents various methods for calculating the PTP for the presence of obstructive CAD. In the latest methods of the ESC Guideline 2024, cardiovascular risk factors, previous findings or the calcium score are included in the calculation in addition to age, gender and symptoms, which increases the accuracy of the prediction. The advantages and disadvantages of the various methods are explained using case studies.