Clinical Implications of Moderate Coronary Stenosis on Coronary Computed Tomography Angiography in Patients with Stable Angina.
10.3349/ymj.2018.59.8.937
- Author:
Choongki KIM
1
;
Sung Jin HONG
;
Chul Min AHN
;
Jung Sun KIM
;
Byeong Keuk KIM
;
Young Guk KO
;
Byoung Wook CHOI
;
Donghoon CHOI
;
Yangsoo JANG
;
Myeong Ki HONG
Author Information
1. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. mkhong61@yuhs.ac
- Publication Type:Original Article
- Keywords:
Coronary artery disease;
coronary stenosis;
computed tomography angiography
- MeSH:
Angina, Stable*;
Angiography*;
Arteries;
Body Weight;
Cohort Studies;
Constriction, Pathologic;
Coronary Angiography;
Coronary Artery Disease;
Coronary Stenosis*;
Diagnosis;
Humans;
Incidence;
Information Systems;
Prospective Studies
- From:Yonsei Medical Journal
2018;59(8):937-944
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The present study investigated the diagnostic accuracy and clinical implications of moderate stenosis (50–69%, Coronary Artery Disease Reporting and Data System, grade 3) on coronary computed tomography angiography (CCTA), compared with invasive coronary angiography (ICA). MATERIALS AND METHODS: Two hundred and seventy-six patients who underwent ICA due to moderate stenosis alone on CCTA were selected from our prospective registry cohort. RESULTS: Diagnostic concordance between CCTA and ICA was found in only 50 (18%) patients. Among the 396 vessels and 508 segments with moderate stenosis, diagnostic concordance was found in 132 vessels (33%) and 127 segments (25%). Segments with calcified plaque had lower diagnostic concordance than those with mixed or non-calcified plaque (22% vs. 28% vs. 27%, respectively, p=0.001). While calcified plaque burden did not have an influence on severe stenosis (≥70%) on ICA, higher burden of non-calcified plaque was correlated with a greater incidence of ICA-based severe stenosis, which was more frequent in patients with ≥3 segments of non-calcified plaque (75%) than those without non-calcified plaque (22%, p < 0.001). Typical angina and mixed or non-calcified plaque were correlated with a higher incidence of under-diagnosis, while the use of next-generation computed tomography scanners reduced the incidence of under-diagnosis. Increased body weight, left circumflex artery involvement, and calcified plaque were independent factors that increased the risk of over-diagnosis of CCTA. CONCLUSION: The diagnosis of moderate stenosis by CCTA may be limited in estimating the exact degree of ICA-based anatomical stenosis. Unlike calcific burden, non-calcific burden was positively correlated with the presence of severe stenosis on ICA.
