Original Title: Tomodensitométrie cardiaque pour la stratification du risque dans l’évaluation de la douleur rétrosternale de type angineuse

Authors' objectives: This report assesses the relevance of integrating cardiac computed tomography angiography (CCTA) into care pathways at the Quebec Heart and Lung Institute – Laval University (IUCPQ–ULaval) for risk stratification in patients presenting with angina-type chest pain.

Authors' results and conclusions: International guidelines recommend coronary cardiac computed tomography (CCT) as an initial test for patients without known coronary artery disease (CAD), especially in emergency settings with normal electrocardiogram (ECG) and troponin results. For patients with established CAD, recommendations are more nuanced and do not consistently prioritize CCT over functional imaging tests. Evidence indicates high sensitivity (94–98%) and excellent negative predictive value, with a safety profile comparable to other modalities. CCT, however, involves exposure to radiation. From an economic perspective, CCT is considered cost-effective for low- to intermediate-risk patients, with total costs lower than single-photon emission computed tomography (SPECT) and positron emission tomography (PET). Although no budget impact scenario is presented due to clinical and organizational decision-making factors related to increasing access to CCT, available data suggest that the budgetary impact would be minimal for the Institute.

Authors' recommendations: In this context, it is recommended that the Institute introduce the use of CCT in the emergency department for the evaluation of patients presenting with chest pain and a low to intermediate risk of coronary artery disease (CAD). It is also recommended that the Institute continue its use in cardiology units for the management of new patients who have not previously undergone an intervention to treat CAD. Lastly, it is not recommended to offer CCT for the evaluation of patients with known CAD, namely those who have already undergone coronary artery bypass grafting or percutaneous coronary intervention.

Project Status: Completed

URL for project: https://www.iucpq.ca/a-propos-de-nous/excellence/evaluation-des-technologies-et-modes-dintervention-en-sante/

Year Published: 2025

URL for published report: https://www.iucpq.ca/tomodensitometrie-cardiaque-pour-la-stratificationdu-risque-dans-levaluation-de-la-douleur-retrosternale-de-type-angineuse/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

DOI: https://doi.org/10.60918/21282

Organisation Name: Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval (IUCPQ-ULaval)

Contact Address: 2725, chemin Sainte-Foy Québec QC G1V 4G5

Contact Name: uetmis.iucpq@ssss.gouv.qc.ca

Contact Email: uetmis.iucpq@ssss.gouv.qc.ca

Copyright: Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval