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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Clinical Implications of Moderate Coronary Stenosis on Coronary Computed Tomography Angiography in Patients with
Choongki Kim1, Sung Jin Hong1, Chul Min Ahn1,2
1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
Coronary computed tomography angiography (CCTA) shows limited accuracy in diagnosing moderate coronary artery stenosis compared to invasive coronary angiography (ICA). Non-calcified plaque burden on CCTA, however, correlates with severe stenosis on ICA.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Radiology
Background:
- Coronary computed tomography angiography (CCTA) is a non-invasive imaging modality for assessing coronary artery disease (CAD).
- Accurate stenosis grading is crucial for guiding revascularization decisions.
- Moderate stenosis (50-69%) poses diagnostic challenges in differentiating significant from non-significant lesions.
Purpose of the Study:
- To evaluate the diagnostic accuracy of CCTA in identifying moderate coronary artery stenosis (50-69%) compared to invasive coronary angiography (ICA).
- To explore the clinical implications and factors influencing diagnostic discrepancies between CCTA and ICA for moderate stenosis.
Main Methods:
- A prospective registry cohort of 276 patients undergoing ICA for moderate stenosis on CCTA was analyzed.
- Diagnostic concordance between CCTA and ICA was assessed for vessels and segments.
- Factors influencing under-diagnosis and over-diagnosis by CCTA were investigated.
Main Results:
- Low diagnostic concordance (18%) was observed between CCTA and ICA for moderate stenosis.
- Non-calcified plaque burden on CCTA correlated positively with the presence of severe stenosis (≥70%) on ICA.
- Typical angina, non-calcified plaque, increased body weight, and specific artery involvement were associated with diagnostic discrepancies.
Conclusions:
- CCTA's ability to accurately estimate the anatomical severity of moderate coronary artery stenosis is limited when compared to ICA.
- Non-calcified plaque burden on CCTA is a significant predictor of actual severe stenosis on ICA, unlike calcified plaque burden.
Purpose:
The present study investigated the diagnostic accuracy and clinical implications of moderate stenosis (50-69%, Coronary Artery Disease Reporting and Data System, grade 3) on coronary computed tomography angiography (CCTA), compared with invasive coronary angiography (ICA).
Materials And Methods:
Two hundred and seventy-six patients who underwent ICA due to moderate stenosis alone on CCTA were selected from our prospective registry cohort.
Results:
Diagnostic concordance between CCTA and ICA was found in only 50 (18%) patients. Among the 396 vessels and 508 segments with moderate stenosis, diagnostic concordance was found in 132 vessels (33%) and 127 segments (25%). Segments with calcified plaque had lower diagnostic concordance than those with mixed or non-calcified plaque (22% vs. 28% vs. 27%, respectively, p=0.001). While calcified plaque burden did not have an influence on severe stenosis (≥70%) on ICA, higher burden of non-calcified plaque was correlated with a greater incidence of ICA-based severe stenosis, which was more frequent in patients with ≥3 segments of non-calcified plaque (75%) than those without non-calcified plaque (22%, p<0.001). Typical angina and mixed or non-calcified plaque were correlated with a higher incidence of under-diagnosis, while the use of next-generation computed tomography scanners reduced the incidence of under-diagnosis. Increased body weight, left circumflex artery involvement, and calcified plaque were independent factors that increased the risk of over-diagnosis of CCTA.
Conclusion:
The diagnosis of moderate stenosis by CCTA may be limited in estimating the exact degree of ICA-based anatomical stenosis. Unlike calcific burden, non-calcific burden was positively correlated with the presence of severe stenosis on ICA.
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