Potential intrinsic error of noninvasive coronary angiography

With current noninvasive techniques compromises have to be accepted for coronary imaging, e.g., partial coverage of the coronary artery tree. The aim of the study was to estimate the potential intrinsic error of partial coverage from a database of invasive angiograms.

The localization and severity of coronary artery stenoses and, if percutaneous coronary intervention (PCI) was performed, the balloon and stent size were extracted from a large database of 21,335 selective coronary angiograms. Of stenoses with >50% diameter reduction, 31.4% were located in distal segments and minor side branches, constituting 28.8% of interventional treatment. In 5% of patients undergoing their first invasive angiogram, the most proximal relevant stenosis was found in a distal segment or minor side branch. Most interventions (83.5%) were performed in main coronary artery segments.

Coronary artery stenoses were found and interventional treatment performed in all coronary segments. Therefore, noninvasive coronary imaging of only proximal and medial segments and major side branches is an inadequate strategy for complete diagnosis or as a guide to therapeutic decisions. However, the currently available noninvasive techniques allow the detection of relevant stenoses in 95% of patients with suspected coronary artery disease (CAD) to prepare for further invasive diagnostic and therapeutic planning.