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A review of adherence to the guidelines for coronary CT angiography quantitative stenosis grading thresholds in
Andres E Carmona-Rubio1, Ashley Mingshin Lee, Stefan Puchner
1Department of Medicine, University at Buffalo, State University of New York, School of Medicine , Buffalo, NY.
Insights
A review of coronary computed tomography angiography (CCTA) studies found that most research does not consistently follow guidelines for defining coronary stenosis severity. This lack of standardization hinders accurate interpretation of potentially significant blockages.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Coronary stenosis severity is crucial for interpreting coronary computed tomography angiography (CCTA) findings.
- Existing literature shows variability in defining hemodynamically significant stenosis.
- Societal guidelines provide recommended thresholds for stenosis grading.
Purpose of the Study:
- To survey thresholds used for defining significant coronary stenosis in CCTA research.
- To assess adherence to established guidelines in recent CCTA publications.
Main Methods:
- Systematic review of original research articles on CCTA.
- Inclusion criteria: studies with > 25 subjects.
- Stratification of lesion severity reporting: ≥ 50%, 50% to 69%, and other methods.
Main Results:
- Fifty-nine studies met inclusion criteria.
- Eighteen studies used 50% to 69% for moderate stenosis; 35 used ≥ 50% for significant stenosis.
- Six studies employed alternative thresholds; only 18 precisely followed guideline thresholds for moderate and severe stenosis.
Conclusions:
- A majority of studies published since 2009 do not adhere to societal guidelines for stenosis grading.
- Inconsistent reporting of coronary stenosis degree complicates interpretation.
- Improved standardization in CCTA reporting is needed for clinical consistency.
Background:
The degree of coronary stenosis of potential hemodynamic significance is central to the interpretation of coronary computed tomography angiography (CCTA), but has been variably defined in the literature. Societal guidelines have attempted to address this issue via recommended thresholds.
Objectives:
We surveyed the various thresholds for defining significant coronary stenosis reported in research published since the introduction of the Society for Cardiovascular Computed Tomography guidelines regarding the interpretation and reporting of CCTA.
Methods:
We systematically reviewed the results of bibliographic searches of all original research articles on CCTA, focusing on studies reporting > 25 subjects, to assess the definitions of severity of coronary lesions as found on CCTA. To enable comparisons, we stratified the methods of reporting lesion severity into ≥ 50%, 50% to 69%, and "others" (including infrequent reporting methods).
Results:
Fifty-nine11 published studies were identified and met inclusion criteria. Eighteen studies reported the severity of coronary stenosis using a definition of 50% to 69% as moderate stenosis; 35 studies defined ≥ 50% coronary stenosis as "stenosis," "significant stenosis," or "obstructive lesion" without distinguishing a threshold for moderate versus severe stenosis. Six studies utilized other thresholds, such as 20% to 75%, 40% to 69%, 40% to 70%, 40% to 79%, and 50% to 75% to define moderate coronary stenosis.
Conclusions:
Fifty-three of 59 studies were graded in accordance with the recommended threshold of ≥ 50% defining potentially significant stenosis, with 18 studies reporting precisely in accordance with the guidelines-recommended thresholds of ≥ 50% narrowing as defining moderate stenosis and ≥ 70% narrowing as defining severe stenosis. Six studies were reported using alternative thresholds for significant stenosis. However, a majority of research studies published since 2009 do not follow the societal guidelines for stenosis grading, since these studies do not clearly describe the degree of coronary stenosis.
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