Myocardial Computed Tomography Perfusion: One More Piece on The Board

摘要

The most appropriate way to evaluate patients with stable coronary artery disease (CAD) and the subsequent definition of the therapeutic approach has been the subject of debate in recent years. For several years the anatomical evaluation was considered sufficient to indicate myocardial revascularization. The emergence of several methods of non-invasive functional evaluation in clinical practice as well as data from observational studies demonstrating that there is a level of ischemia above which a revascularization strategy might result in benefit regarding cardiovascular events raised doubts whether an strategy based in coronary anatomic findings was the best option. This questioning changed the paradigm of CAD evaluation. Although randomized clinical trials have failed to demonstrate that the extent of ischemia can determine which patients would benefit from a revascularization strategy, the fact that the presence of moderate to severe ischemia is undeniably a marker of cardiovascular risk has lead functional evaluation to become a fundamental part in the management of patients with stable CAD.