Diagnostic Adequacy of Pre-TAVI CTA Compared With ICA and Its Prognostic Association With Coronary Artery Disease

Previous studies have investigated the concordance between pre-TAVI coronary CT angiography (CTA) and invasive coronary angiography (ICA).

To evaluate the agreement between pre-TAVI coronary CTA and ICA and to determine the relationship between coronary artery disease and one-year survival: MATERIALS AND METHODS: Coronary CTA findings were compared with invasive coronary angiography in patients undergoing TAVI for severe aortic stenosis at our tertiary care center between November 2023 and November 2024, with 50% and 70% stenosis used as diagnostic cut-off values.

Ninety-five patients who underwent both coronary CTA and invasive coronary angiography prior to TAVI were included. Obstructive CAD was defined as ≥ 70% stenosis in the right coronary, left anterior descending, or circumflex artery, or ≥ 50% stenosis in the left main coronary artery. CTA findings showed strong agreement with invasive coronary angiography across all coronary arteries. At the 70% stenosis threshold, CTA demonstrated high sensitivity and specificity, with excellent interobserver agreement. Obstructive CAD was present in 82.1% of patients, with single-, two-, and three-vessel disease observed in 15.8%, 18.9%, and 47.4%, respectively. Severe carotid artery stenosis (> 70%) was observed in a minority of patients. One-year survival was 93.7% and was not associated with the presence of CAD (p = 0.466).

Pre-TAVI coronary CTA shows strong agreement with invasive coronary angiography for detecting obstructive coronary stenosis and represents a practical, noninvasive option for coronary assessment before TAVI.