Diagnostic Accuracy of Coronary CT Angiography in Ruling Out Significant Coronary Artery Disease in Candidates for...

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Obstructive coronary artery disease (CAD) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI).
• Invasive coronary angiography (ICA) is the standard for coronary evaluation, but coronary computed tomography angiography (cCTA) is emerging as a non-invasive alternative.
• Pre-procedural assessment of CAD is crucial for TAVI candidates.

Purpose of the Study:

• To evaluate the diagnostic accuracy of cCTA in excluding significant obstructive CAD in patients scheduled for TAVI.
• To compare the performance of cCTA against ICA, the gold standard, in this patient population.

Main Methods:

• Retrospective analysis of 95 TAVI candidates who underwent both cCTA and ICA.
• Assessment of cCTA diagnostic performance (sensitivity, specificity, PPV, NPV, accuracy) using ICA as the reference standard.
• Analysis performed on both patient- and vessel-based models, defining obstructive CAD as ≥50% stenosis or occlusion.

Main Results:

• ICA identified obstructive CAD in 28.4% of patients.
• Excluding non-evaluable scans, cCTA demonstrated high NPV (97% patient-level, 95% vessel-level) and accuracy (85% patient-level, 87% vessel-level).
• Even with non-diagnostic scans included, NPV remained high (97%), though overall accuracy decreased (67-66%).

Conclusions:

• cCTA shows high accuracy in ruling out significant CAD in TAVI candidates, with consistently high NPV.
• A notable rate of non-diagnostic cCTA scans was observed.
• cCTA can serve as a valuable complementary tool to ICA, potentially reducing the need for invasive procedures in select TAVI patients.