Coronary computed tomography angiography guidance for selective invasive coronary angiography; a prospective registry...

Coronary computed tomography angiography (CCTA) offers excellent negative predictive value for coronary artery disease (CAD). In suspected single-vessel disease, invasive coronary angiography (ICA) could be simplified by deferring visualization of the normal coronary artery as identified on CCTA. This ultraselective ICA strategy might reduce procedure time, contrast use, and radiation exposure. This prospective study evaluated the potential benefits of this strategy.

This was a multicentre prospective registry in three hospitals in the Netherlands. The study included patients over 18 years undergoing ICA for suspected CAD limited to a single coronary artery on CCTA. The primary endpoint was accuracy of CCTA in predicting a normal coronary artery on ICA. Secondary endpoints included potential reductions in procedure time, radiation exposure, and contrast volume with an ultraselective ICA approach.

In total 102 patients were included. CCTA was correct in predicting a non-obstructive coronary artery in all patients (100 ​%). By deferring visualization of the normal coronary, a CCTA-guided ICA would have led to a reduction in procedure time (49 ​% [IQR 41-59]; 6.64 ​min [5.07-8.68] vs 3.18 ​min [2.42-4.41]), radiation exposure (35 ​% [25-44]; 5.09 ​Gy ​cm² [3.11-7.88] vs 3.17 ​Gy ​cm² [1.96-5.08]), and the amount of contrast agent used (33 ​% [28-41]; 71 ​ml [60-84] vs 46 ​ml [37-55]).

This study demonstrated excellent performance of CCTA in predicting a normal coronary artery in patients with suspected single-vessel CAD. A CCTA-guided ultraselective ICA is feasible and offers substantial reductions in procedure time and materials, contrast agent volume and radiation exposure.