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Can Discrepancies Between Coronary Computed Tomography Angiography and Cardiac Catheterization in High-Risk Patients
Sharon Steinberger1, Andrew J Plodkowski, Larry Latson
1From the Departments of *Radiology, †Medicine, and ‡Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
Insights
Coronary computed tomography angiography (CTA) showed good agreement with catheterization for detecting severe stenosis. Clinical CTA interpretation offered higher sensitivity, supporting its use in practice.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Interventional Cardiology
Background:
- Coronary computed tomography angiography (CTA) is increasingly used for diagnosing coronary artery disease.
- Discrepancies between CTA and catheterization can impact patient management.
- High-risk, diverse populations may present unique challenges for CTA interpretation.
Purpose of the Study:
- To evaluate the accuracy of coronary CTA compared to catheterization in a high-risk, inner-city population.
- To identify the causes and incidence of discrepancies between the two imaging modalities.
- To compare the diagnostic performance of clinical CTA interpretation versus expert panel review.
Main Methods:
- Retrospective analysis of 92 patients who underwent both coronary CTA and catheterization.
- Comparison of clinical CTA interpretation and expert panel reinterpretation against catheterization results.
- Assessment of sensitivity and specificity for detecting severe stenosis.
Main Results:
- Catheterization revealed severe stenosis in 65% of patients.
- Clinical CTA interpretation was concordant with catheterization in 78% of cases.
- Panel interpretation showed similar concordance (77%), but with different sensitivity and specificity profiles.
Conclusions:
- Coronary CTA demonstrates substantial agreement with catheterization for severe coronary stenosis.
- Clinical CTA interpretation exhibited higher sensitivity, aligning with clinical practice favoring overestimation of ambiguous stenoses.
- Both interpretation methods provide valuable, albeit different, diagnostic information.
Objective:
To assess the incidence and cause of discrepancies between coronary computed tomography angiography (CTA) and catheterization in a high-risk, diverse, predominantly overweight inner-city population.
Methods:
Ninety-two patients who underwent coronary CTA and catheterization on March 2007 to December 2012 were retrospectively identified. Clinical coronary CTA interpretation and reinterpretation by a review panel was compared with catheterization results.
Results:
Severe stenosis was present on catheterization in 65% (60/92). Clinical coronary CTA was concordant with catheterization for severe stenosis in 78% (72/92), whereas panel interpretation was concordant in 77% (70/91). Sensitivity and specificity of clinical and panel coronary CTA interpretations were 92% (55/60) and 53% (17/32) versus 82% (48/59) and 68% (22/32), respectively.
Conclusions:
Both coronary CTA interpretations were concordant with catheterization for severe stenosis in three quarters of patients. However, the diagnostic profile of the 2 interpretations differed, with higher sensitivity for the clinical report. This supports the clinical practice, which favored overestimation of difficult to quantify stenoses.
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