Diagnostic accuracy of CCTA versus ICA for detecting coronary artery disease in TAVI patients: a systematic review and meta-analysis

Abstract Introduction Current guidelines recommend screening for coronary artery diseases before valvular interventions and computed coronary tomography angiography (CCTA) has been widely used in patients undergoing transcatheter aortic valve implantation (TAVI). Purposes This meta-analysis evaluates the diagnostic accuracy of CCTA versus invasive coronary angiography (ICA) as the gold standard test, in patients undergoing TAVI, using segment-level data. Methods A systematic search identified 3723 studies; 13 studies with 2477 patients were finally included. Quality was assessed with QUADAS-2. A random-effects meta-analysis was performed with subgroup analyses by imaging protocol (dual-source or photon-counting CTA, single-source CTA, CT-FFR). The pooled diagnostic odds ratio (DOR) and area under the curve (AUC) were computed for both 50% and 70% stenosis thresholds. Results Our analysis demonstrated pooled sensitivity of 0.83 (95% CI: 0.74–0.92) and 0.90 (95% CI: 0.83–0.98) for CCTA regarding 50% and 70% stenosis, respectively. The pooled specificity was similarly high, at 0.83 (95% CI: 0.75–0.91) for 50% stenosis and 0.85 (95% CI: 0.79–0.92) for 70% stenosis. The meta-analysis revealed a pooled DOR of 41.04 (95% CI: 15.46-108.92) and 39.71 (95% CI: 32.86-47.99) in segment-level data at 50% and 70% stenosis, respectively. Additionally, the sROC curve suggested strong diagnostic performance of CCTA, with areas under the curve (AUC) of 92.50% and 93.18% for 50% and 70% stenosis, respectively. Regarding subgroup analysis at 50% stenosis threshold, dual−source or photon−counting CTA resulted in pooled sensitivity of 0.85 (95% CI: 0.78–0.93) and pooled specificity of 0.80 (95% CI: 0.71–0.92), while single−source CTA had pooled sensitivity and specificity of 0.92 (95% CI: 0.80–1.00) and 0.83 (95% CI: 0.63–1.00), respectively. The pooled sensitivity and specificity of CT-FFR in TAVI patients were 0.55 (95% CI: 0.50–0.62) and 0.89 (95% CI: 0.86–0.92), respectively. Additionally, regarding the 70% stenosis threshold, dual−source or photon−counting CTA had a pooled sensitivity of 0.90 (95% CI: 0.83–0.98) and a pooled specificity of 0.85 (95% CI: 0.79–0.92) for detecting coronary artery diseases. Conclusion CCTA demonstrates sustained high sensitivity, DOR, and AUC across different thresholds and imaging protocols, making it a reliable non-invasive alternative to ICA for ruling out significant coronary artery disease in TAVI patients. However, its moderate specificity suggests a potential role in excluding rather than a definitive diagnosis.