You are here

  • Home
  • Archive
  • Volume 7, Issue 1
  • Clinical impact of CT coronary angiography without exclusion of small coronary artery segments: a real-world and long-term study

Article Text

Article menu

Download PDFPDF

Coronary artery disease
Original research
Clinical impact of CT coronary angiography without exclusion of small coronary artery segments: a real-world and long-term study
  1. Yannick Logghe1,
  2. Lieven Van Hoe2,
  3. Piet Vanhoenacker2,
  4. Olivier Bladt2,
  5. Philip Simons2,
  6. Erik Kersschot2 and
  7. Carlos Van Mieghem3
  1. 1Anesthesiology, University Hospital Antwerp, Edegem, Antwerp, Belgium
  2. 2Radiology, OLV Ziekenhuis Campus Aalst, Aalst, Oost-Vlaanderen, Belgium
  3. 3Cardiology, AZ Groeninge, Kortrijk, West-Vlaanderen, Belgium
  1. Correspondence to Dr Carlos Van Mieghem; carlos.vanmieghem{at}azgroeninge.be

Abstract

Objectives CT coronary angiography (CTCA) has become a valuable diagnostic test in the workup of patients with possible coronary artery disease (CAD). Because of inherent limitations in spatial resolution, epicardial vessels with a small diameter, in general less than 1.5–2 mm, have so far been excluded in studies assessing clinical utility of CTCA. This study sought to assess the clinical impact of CTCA taking into account pathology in small coronary arteries.

Methods We conducted a retrospective cohort study of all patients with possible CAD who underwent dual-source CTCA and subsequent invasive coronary angiography (ICA) between January 2010 and July 2017. Patients with an Agatston calcium score ≥1000 were reported separately. Diagnostic accuracy of CTCA on a patient, vessel and segment level was calculated. The physician’s therapeutic decision was defined as conservative, medical antianginal treatment or revascularisation. Using ICA as the reference, we calculated the precision of CTCA to replicate these therapeutic recommendations.

Results In total, 1209 patients underwent both CTCA and ICA. Overall diagnostic performance of CTCA showed a sensitivity of 90% (95% CI 86% to 93%) and specificity of 40% (95% CI 36% to 45%). With regard to clinical decision making, CTCA showed good performance: 91% of patients who were treated medically or by revascularisation were correctly identified. Prevalence of disease in small vessel segments was low: 16% showed significant CAD on ICA. Prevalence of significant disease was 70% in patients with an Agatston score ≥1000: the majority underwent revascularisation.

Conclusions From a true patient perspective, without exclusion of smaller coronary artery segments, CTCA allows safe patient management.

  • coronary artery disease
  • imaging and diagnostics
  • CT scanning
  • coronary angiography
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2019-001222

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors YL: methodology, data curation, original draft preparation, writing, software, visualisation. LVH: data curation, reviewing and editing. PV: data curation, reviewing and editing. OB: data curation, reviewing and editing. PS: data curation, reviewing and editing. EK: data curation, reviewing and editing. CVM: Conceptualisation, methodology, original draft preparation, data curation, writing, reviewing and editing, supervision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The Ethical Committee of the OLV Hospital Aalst approved the study protocol, and all patients gave written informed consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. All data can be obtained by the corresponding author CVM.