Indications for multidetector computed tomographic coronary angiography after catheter-based coronary angiography

OBJECTIVES: This study was designed to evaluate the indications for performing multidetector computed tomographic coronary angiography (MDCTA) after catheter-based coronary angiography. BACKGROUND: Appropriateness criteria for MDCTA apply exclusively to patient evaluation prior to catheter-based angiography. METHODS: All MDCTA performed after catheterbased angiography at a tertiary referral center were reviewed. RESULTS: Fourteen of a total of 2,000 MDCTAs (0.7%) fulfilled the criteria: 14 were performed after catheter-based angiography. The indications were: 1) inability to selectively cannulate a native vessel or graft; 2) severe pressure damping limiting safe angiography; 3) ostial disease; 4) course of anomalous vessels; 5) relationship of bypass grafts to the sternum; 6) graft morphology; 7) chronic total occlusions. In all cases, the MDCTA enabled definitive treatment. CONCLUSIONS: In a variety of scenarios, MDCT coronary angiography may provide essential information as an adjunctive tool after catheter-based angiography. Indications for MDCTA should be expanded to accommodate these clinical necessities.