some pre- and postoperative settings [11]. A recent
meta-analysis supports the use of CCTA as a first imaging
test for low- and intermediate-risk patients presenting
to the emergency department with chest pain
[29]. The role of CCTA remains uncertain in asymptomatic
high-risk patients like patients with T2DM, and even
if there are reports finding a prognostic value of CCTA
[8, 9] there is another recent study reporting that use of
CCTA to screen asymptomatic patients with T2DM do
not improve clinical outcome [30]. One study in patients
with T2DM and mild anginal complaints demonstrated
a crucial impact of ischemia on cardiac event rate and
showed a prognostic value of myocardial perfusion scintigraphy
(MPS [31], and a possible strategy may be to
perform supplementary MPS in asymptomatic patients
with positive CCTA. Another possible future improvement
of screening CCTA may be a combination with
computed tomography myocardial perfusion imaging, as
there are recent promising reports about this method
[32, 33], or to combine results of CCTA with prognostic
biomarkers [34].
The relatively small number of included patients is a
limitation of the generalizability of the study results, including
the relatively low proportion of female patients