CCTA 75574 – Care to Care's Clinical Criteria

NOTE: Any of the following require physician review:

Atrial fibrillation

Fast heart rate, inability to take beta blockade

Frequent premature atrial or ventricular contractions with irregular heart rhythm

Known severe coronary artery calcifications (i.e., coronary calcium score >1000-1500 Agatston units)

Morbid obesity

Screening test of asymptomatic patient

Serum creatinine >2.0 mg/dL

1 For mapping of coronary veins prior to biventricular pacing

2 For mapping of left atrium and pulmonary veins prior to ablation procedure

3 For Evaluation of Coronary Artery Disease 75574

3.1 Congestive heart failure

3.1.1 No stress or angiographic studies in prior 60 days

3.1.2 Evaluation of coronary arteries in patients with new onset heart failure to assess etiology

3.2 Acute Chest pain [ALL]

3.2.1 Low to Intermediate pretest probability of CAD See Chart Below

3.2.2 No ECG changes

3.2.3 Serial enzymes negative

3.3 Chest Pain Syndrome includes any of the following: chest pain, tightness, and burning, dyspnea, shoulder or jaw pain

3.3.1 Low to Intermediate pretest probability of CAD See Chart Below

3.3.2 ECG uninterpretable or unable to exercise (for stress test)

3.4 Abnormal or Equivocal Stress Test

3.4.1 No chest pain

3.4.2 Catheterization not planned

3.5 Incomplete prior coronary angiogram

3.6 In place of coronary angiogram in cases with difficult vascular access or at risk due to anticoagulation.

3.7 Evaluation of suspected coronary aretery anomaly

3.8 Prior to noncoronary cardiac or other high risk surgery

3.9

3.10 References:

American College of Radiology. ACR Appropriateness Criteria®. Acute nonspecific chest pain; low probability of coronary artery disease. Initial imaging. Available at https://acsearch.acr.org/list .Accessed 11/2/2020.

Mark, Daniel B., Berman, Daniel S., Budoff, Matthew J., Carr, J. Jeffrey, Gerber, Thomas C., Hecht, Harvey S., Hlatky, Mark A., Hodgson, John McB., Lauer, Michael S., Miller, Julie M., Morin, Richard L., Mukherjee, Debabrata, Poon, Michael, Rubin, Geoffrey D., Schwartz, Robert S. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents J Am Coll Cardiol 2010 55: 2663-2699

Thompson Randall C, Thomas Gregory S, “Coronary Angiography by Computed Tomography” (Update). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison’s Principles of Internal Medicine, 17e: http://www.accessmedicine.com/updatesContent.aspx?aid=1000672.

Thompson RC et al: Potential indications of coronary angiography by computed tomography (CT). Am Heart Hosp J 3:161, 2005b