Clinical utility of coronary computed tomography angiography in patients diagnosed with high-grade stenosis of the coronary arteries. Issue 7 (November 2019)

• Record Type: Journal Article
• Authors: Kim, Choongki; Hong, Sung-Jin; Shin, Sanghoon; Ahn, Chul-Min; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Choi, Byoung-Wook; Choi, Donghoon; Jang, Yangsoo; Hong, Myeong-Ki
• Is Part Of: Coronary artery disease. Volume 30:Issue 7(2019:Nov.)
• Publication Date: 2019-11
• Subjects: computed tomography angiography -- coronary angiography -- coronary artery disease; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000000750
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : Objectives: We purposed to evaluate the reliability of coronary computed tomography angiography (CCTA) in patients with a CCTA finding of high-grade stenosis. Patients and methods: Between May 2015 and March 2017, patients who underwent invasive coronary angiography (ICA) because of detection of high-grade stenosis by CCTA ( ≥ 70% stenosis of epicardial arteries or ≥ 50% of the left main coronary artery; Coronary Artery Disease Reporting and Data System grade 4 or 5) were selected for this study from our prospective registry cohort. Results: Among 646 eligible patients, only 263 (41%) patients were correctly diagnosed with significant coronary artery disease on ICA as same as CCTA findings. The per-vessel analysis revealed that 620 (68%) of 916 affected vessels had confirmed concordant significant stenosis between the CCTA and ICA results. The concordance rate was 49% among the segments with identified plaques in the per-segment analysis. Revascularization of the target vessel identified with severe stenosis by CCTA was performed in 228 (35%) patients. A logistic regression analysis revealed that smoking [odds ratio (OR): 1.59, 95% confidence interval (CI): 1.04–2.42, P = 0.03], taller height (OR: 1.02, 95% CI: 1.00–1.05, P = 0.016), and presence of typical symptoms of angina (OR: 1.86, 95% CI: 1.34–2.59, P < 0.001) were found to increase the probability of diagnostic concordance. A greater calcified segment involvement score (OR: 0.88, 95% CI: 0.82–0.94, P < 0.001) was associated with a lower diagnostic concordance. Conclusion: The diagnostic discordance between CCTA and ICA was frequently observed in patients who were diagnosed with a CCTA finding of high-grade stenosis.