CTA showed 99.2% NPV per patient for severe proximal coronary stenosis, reducing invasive angiography need before TAVI; CACS and lesion burden predicted 5-year mortality.
Does computed tomography angiography accurately detect severe coronary artery stenoses compared to invasive quantitative coronary angiography in patients awaiting TAVI?
CTA is highly accurate in ruling out severe coronary artery disease prior to TAVI, potentially reducing the need for routine invasive coronary angiography.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Prior to transcatheter aortic valve implantation (TAVI), significant proximal coronary artery stenoses must be excluded to optimize patient outcomes. Traditionally, invasive coronary angiography (ICA) has been the standard for this assessment. However, emerging evidence suggests that non-invasive computed tomography angiography (CTA) may serve as a viable alternative. Purpose This study evaluates the accuracy of CTA performed during the CT TAVI scan compared to invasive quantitative coronary angiography (QCA) in detecting severe coronary artery stenoses in patients with severe aortic stenosis awaiting TAVI. Additionally, it examines the prognostic value of CTA and QCA derived markers in predicting post-TAVI outcomes. Methods A retrospective analysis was conducted on 184 patients from a single centre who underwent both CTA and ICA with QCA assessment before TAVI. Severe stenosis was defined as ≥70% luminal narrowing in a major epicardial artery or ≥50% in the left main coronary artery. Per-patient and per-vessel analyses were performed across the coronary tree (proximal, mid, and distal segments). Simple logistic regression was used to assess CTA and QCA variables as predictors of five-year post-TAVI mortality. Results Severe proximal coronary disease was identified in 3.3% of patients, while severe stenoses anywhere in the coronary tree were observed in 6.8%. CTA demonstrated a high negative predictive value (NPV) for detecting severe proximal disease (99.2% per patient, 99.7% per vessel), with sensitivity and specificity of 83.3% and 71.3% (per patient) and 66.7% and 90.6% (per vessel), respectively. CTA specificity decreased with increasing coronary calcium score (CCS): mild (95.2%), moderate (90.3%), and severe (62.6%), though NPV remained high (98%) across all groups. No significant difference in CTA accuracy was observed between flash and prospective scanning protocols. Coronary artery calcium score (CACS) and total severe lesion burden detected by CTA were the only significant predictors of five-year post-TAVI mortality. Conclusion CTA is highly accurate in ruling out severe coronary artery disease in pre-TAVI assessment, reducing the need for invasive coronary angiography in most patients. Additionally, CTA-derived markers, including CACS and total lesion burden, provide valuable prognostic insights for risk stratification in TAVI candidates.
Anwar et al. (Sat,) reported a other. CTA showed 99.2% NPV per patient for severe proximal coronary stenosis, reducing invasive angiography need before TAVI; CACS and lesion burden predicted 5-year mortality.