Ultra-high-resolution CT vs. invasive angiography for detecting hemodynamically significant coronary artery disease:
Bruna R Scarpa Matuck1, Naruomi Akino2, Hooman Bakhshi1
1Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Ultra-high-resolution CT (UHR-CT) shows promise for diagnosing coronary artery disease (CAD) in patients with severe calcification or stents. This study compares UHR-CT accuracy to invasive coronary angiography (ICA) for detecting significant CAD.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Diagnostic Accuracy Studies
Background:
- Computed tomography (CT) angiography is a leading noninvasive test for coronary artery disease (CAD).
- Severe coronary calcification or stents can limit CT angiography's diagnostic accuracy.
- Ultra-high-resolution CT (UHR-CT) may improve accuracy in these challenging cases.
Purpose of the Study:
- To evaluate the diagnostic accuracy of UHR-CT compared to invasive coronary angiography (ICA).
- To determine if UHR-CT is non-inferior to ICA for detecting hemodynamically significant CAD.
- To assess UHR-CT's utility in high-risk patients with severe coronary calcification or stents.
Main Methods:
- Prospective, international, multicenter diagnostic accuracy study (CORE-PRECISION).
- 150 patients with a history of CAD underwent UHR-CT prior to ICA.
- Quantitative flow ratio (QFR) <0.8 served as the reference standard for hemodynamically significant CAD.
Main Results:
- The primary outcome is the comparative diagnostic accuracy of UHR-CT versus ICA.
- Secondary analyses include vessel-level accuracy, stenosis quantification, and plaque analysis.
- Data analyzed in independent core laboratories.
Conclusions:
- CORE-PRECISION investigates UHR-CT's non-inferiority to ICA for CAD detection in high-risk patients.
- UHR-CT may offer improved diagnostic capabilities for coronary artery disease.
- This study could establish UHR-CT as a new standard for CAD assessment.
Background:
Direct coronary arterial evaluation via computed tomography (CT) angiography is the most accurate noninvasive test for the diagnosis of coronary artery disease (CAD). However, diagnostic accuracy is limited in the setting of severe coronary calcification or stents. Ultra-high-resolution CT (UHR-CT) may overcome this limitation, but no rigorous study has tested this hypothesis.
Methods:
The CORE-PRECISION is an international, multicenter, prospective diagnostic accuracy study testing the non-inferiority of UHR-CT compared to invasive coronary angiography (ICA) for identifying patients with hemodynamically significant CAD. The study will enroll 150 patients with history of CAD, defined as prior documentation of lumen obstruction, stenting, or a calcium score ≥400, who will undergo UHR-CT before clinically prompted ICA. Assessment of hemodynamically significant CAD by UHR-CT and ICA will follow clinical standards. The reference standard will be the quantitative flow ratio (QFR) with <0.8 defined as abnormal. All data will be analyzed in independent core laboratories.
Results:
The primary outcome will be the comparative diagnostic accuracy of UHR-CT vs. ICA for detecting hemodynamically significant CAD on a patient level. Secondary analyses will focus on vessel level diagnostic accuracy, quantitative stenosis analysis, automated contour detection, in-depth plaque analysis, and others.
Conclusion:
CORE-PRECISION aims to investigate if UHR-CT is non-inferior to ICA for detecting hemodynamically significant CAD in high-risk patients, including those with severe coronary calcification or stents. We anticipate this study to provide valuable insights into the utility of UHR-CT in this challenging population and for its potential to establish a new standard for CAD assessment.
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