Comparison of Non-Invasive and Invasive Diagnostic Methods for Coronary Artery Disease: Single-Centre Data

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Accuracy

Background:

• Coronary computed tomography angiography (CCTA) is a key tool for diagnosing stable coronary artery disease.
• Inconsistent agreement between CCTA and invasive coronary angiography (ICA) necessitates further investigation.
• Understanding factors influencing discrepancies is crucial for accurate patient stratification.

Purpose of the Study:

• To evaluate the diagnostic agreement between CCTA and ICA.
• To identify factors contributing to discrepancies in stenosis detection.
• To assess CCTA's role in patient selection for further evaluation.

Main Methods:

• Retrospective analysis of 500 patients undergoing both CCTA and ICA.
• Evaluation of coronary stenoses (≥50%) at segment, vessel, and patient levels.
• Statistical analysis including kappa coefficient, sensitivity, specificity, and logistic regression.

Main Results:

• Low to moderate agreement between CCTA and ICA at the segment level (κ = 0.108-0.461).
• CCTA showed higher sensitivity (91.3%) but lower specificity (21.2%) than ICA at the patient level for ≥50% stenosis.
• Discrepancies linked to coronary calcium burden, BMI > 25 kg/m², younger age (<68 years), and comorbidities.

Conclusions:

• CCTA is a sensitive, non-invasive method for patient selection for further diagnostic evaluation.
• Limited agreement between CCTA and ICA persists at segment and vessel levels.
• Coronary artery calcification and higher BMI are key factors influencing discordant findings.