Study: CTA may be viable alternative to invasive angiography

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 - 3D CCTA
Images in 54-year-old man with atypical chest pain. Contrast-enhanced ECG-synchronized CCTA obtained after SPECT and displayed as 3D volume-rendered image.
Source: Radiology (doi: 10.1148/radiol.12112426)

Coronary computed tomography angiography (CTA) is comparable to traditional invasive angiography for the detection and exclusion of lesion-specific ischemia, according to results of a study recently published online in the Journal of the American College of Cardiology.

While invasive coronary angiography continues to be the first option for diagnosing high-grade coronary stenosis, utilization of CTA as a noninvasive alternative continues to grow within the practice of cardiology, said lead author Matthew Budoff, MD, of the Los Angeles Biomedical Research Center, and colleagues.

“Until recently, invasive angiography has been considered a gold standard for obstructive disease and need for revascularization,” the authors wrote. “[CTA] has been shown to be a highly diagnostic test that results in better cardiovascular outcomes than functional testing, but has been perpetually compared with invasive angiography as a reference standard for diagnostic accuracy.”

Budoff and his team set out to investigate CTA diagnostic performance as compared to invasive angiography for the detection of lesion-specific ischemia using assessments obtained with fractional flow reserve (FFR) as a true reference standard. To do so, they performed both coronary CTA and invasive angiography with FFR on a total of 252 international study participants. Results of the procedures were analyzed and verified by multiple independent core laboratories.

They found that ischemia was present in 151 of 407 lesions according to FFR. Coronary CTA showed comparable diagnostic accuracy (69 percent), sensitivity (79 percent), specificity (63 percent), positive predictive value (55 percent) and negative predictive value (83 percent) to that of invasive angiography (71, 74, 70, 59 and 83 percent, respectively).

“Overall, our study confirmed that [invasive angiography]- and coronary CTA-derived measurements perform similarly for the prediction of lesion-specific ischemia,” the authors concluded. “Although this study validates the continued use of invasive angiography for anatomic assessment of stenosis, it strongly supports the use of coronary CTA for similar diagnoses.”