Related Experiment Video
Updated: Nov 21, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
CT Angiography Followed by Invasive Angiography in Patients With Moderate or Severe Ischemia-Insights From the
G B John Mancini1, Jonathan Leipsic1, Matthew J Budoff2
1Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Coronary computed tomographic angiography (CCTA) accurately identifies significant coronary artery disease (CAD) without left main disease, showing high concordance with invasive coronary angiography (ICA). This finding supports CCTA
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Assessing coronary artery disease (CAD) in patients with high-risk ischemia is crucial.
- The diagnostic performance of coronary computed tomographic angiography (CCTA) against invasive coronary angiography (ICA) in this specific population remains under-evaluated.
- The ISCHEMIA trial provided a unique cohort to assess CCTA's role before invasive procedures.
Purpose of the Study:
- To evaluate the concordance between CCTA and ICA for diagnosing coronary anatomy.
- To determine the accuracy of CCTA in identifying significant coronary artery disease (CAD) in patients within the ISCHEMIA trial.
- To assess CCTA's reliability in excluding left main disease and obstructive CAD before randomization.
Main Methods:
- Concordance rates were calculated per patient comparing CCTA and ICA findings.
- Anatomic significance was defined as ≥50% diameter stenosis (DS) for both imaging modalities.
- Sensitivity analyses included a ≥70% DS threshold for CCTA and assessment of image quality.
Main Results:
- In 1,728 patients, CCTA correctly identified 97.1% as having no left main disease (≥50% DS) and 92.2% as having at least single-vessel CAD.
- Only 4.9% of patients were identified as having no anatomically significant CAD by CCTA.
- Sensitivity analyses using alternative thresholds or image quality criteria yielded similar performance.
Conclusions:
- CCTA demonstrates high concordance with ICA for identifying patients with angiographically significant coronary artery disease (CAD).
- The findings support the use of CCTA prior to randomization in the ISCHEMIA trial for assessing coronary anatomy.
- CCTA is a reliable tool for excluding left main disease and identifying obstructive CAD in high-risk populations.
Objectives:
This study aimed to examine the concordance of coronary computed tomographic angiography (CCTA) assessment of coronary anatomy and invasive coronary angiography (ICA) as the reference standard in patients enrolled in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches).
Background:
Performance of CCTA compared with ICA has not been assessed in patients with very high burdens of stress-induced ischemia and a high likelihood of anatomically significant coronary artery disease (CAD). A blinded CCTA was performed after enrollment to exclude patients with left main (LM) disease or no obstructive CAD before randomization to an initial conservative or invasive strategy, the latter guided by ICA and optimal revascularization.
Methods:
Rates of concordance were calculated on a per-patient basis in patients randomized to the invasive strategy. Anatomic significance was defined as ≥50% diameter stenosis (DS) for both modalities. Sensitivity analyses using a threshold of ≥70% DS for CCTA or considering only CCTA images of good-to-excellent quality were performed.
Results:
In 1,728 patients identified by CCTA as having no LM disease ≥50% and at least single-vessel CAD, ICA confirmed 97.1% without LM disease ≥50%, 92.2% with at least single-vessel CAD and no LM disease ≥50%, and only 4.9% without anatomically significant CAD. Results using a ≥70% DS threshold or only CCTA of good-to-excellent quality showed similar overall performance.
Conclusions:
CCTA before randomization in ISCHEMIA demonstrated high concordance with subsequent ICA for identification of patients with angiographically significant disease without LM disease.
More Related Videos
09:21Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Angina IV: Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests