Clinical utility of coronary computed tomography angiography in patients diagnosed with high-grade stenosis of the coronary arteries

Choongki Kim, Sung Jin Hong, Sanghoon Shin, Chul Min Ahn, Jung Sun Kim, Byeong Keuk Kim, Young Guk Ko, Byoung Wook Choi, Donghoon Choi, Yangsoo Jang, Myeong Ki Hong

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: We purposed to evaluate the reliability of coronary computed tomography angiography (CCTA) in patients with a CCTA finding of high-grade stenosis. PATIENTS AND METHODS: Between May 2015 and March 2017, patients who underwent invasive coronary angiography (ICA) because of detection of high-grade stenosis by CCTA ( ≥ 70% stenosis of epicardial arteries or ≥ 50% of the left main coronary artery; Coronary Artery Disease Reporting and Data System grade 4 or 5) were selected for this study from our prospective registry cohort. RESULTS: Among 646 eligible patients, only 263 (41%) patients were correctly diagnosed with significant coronary artery disease on ICA as same as CCTA findings. The per-vessel analysis revealed that 620 (68%) of 916 affected vessels had confirmed concordant significant stenosis between the CCTA and ICA results. The concordance rate was 49% among the segments with identified plaques in the per-segment analysis. Revascularization of the target vessel identified with severe stenosis by CCTA was performed in 228 (35%) patients. A logistic regression analysis revealed that smoking [odds ratio (OR): 1.59, 95% confidence interval (CI): 1.04-2.42, P = 0.03], taller height (OR: 1.02, 95% CI: 1.00-1.05, P = 0.016), and presence of typical symptoms of angina (OR: 1.86, 95% CI: 1.34-2.59, P < 0.001) were found to increase the probability of diagnostic concordance. A greater calcified segment involvement score (OR: 0.88, 95% CI: 0.82-0.94, P < 0.001) was associated with a lower diagnostic concordance. CONCLUSION: The diagnostic discordance between CCTA and ICA was frequently observed in patients who were diagnosed with a CCTA finding of high-grade stenosis.

Original languageEnglish
Pages (from-to)511-519
Number of pages9
JournalCoronary artery disease
Volume30
Issue number7
DOIs
Publication statusPublished - 2019 Nov 1

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Coronary Stenosis
Coronary Angiography
Odds Ratio
Confidence Intervals
Pathologic Constriction
Coronary Artery Disease
Computed Tomography Angiography
Information Systems
Registries
Coronary Vessels
Arteries
Logistic Models
Smoking
Regression Analysis
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kim, Choongki ; Hong, Sung Jin ; Shin, Sanghoon ; Ahn, Chul Min ; Kim, Jung Sun ; Kim, Byeong Keuk ; Ko, Young Guk ; Choi, Byoung Wook ; Choi, Donghoon ; Jang, Yangsoo ; Hong, Myeong Ki. / Clinical utility of coronary computed tomography angiography in patients diagnosed with high-grade stenosis of the coronary arteries. In: Coronary artery disease. 2019 ; Vol. 30, No. 7. pp. 511-519.
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title = "Clinical utility of coronary computed tomography angiography in patients diagnosed with high-grade stenosis of the coronary arteries",
abstract = "OBJECTIVES: We purposed to evaluate the reliability of coronary computed tomography angiography (CCTA) in patients with a CCTA finding of high-grade stenosis. PATIENTS AND METHODS: Between May 2015 and March 2017, patients who underwent invasive coronary angiography (ICA) because of detection of high-grade stenosis by CCTA ( ≥ 70{\%} stenosis of epicardial arteries or ≥ 50{\%} of the left main coronary artery; Coronary Artery Disease Reporting and Data System grade 4 or 5) were selected for this study from our prospective registry cohort. RESULTS: Among 646 eligible patients, only 263 (41{\%}) patients were correctly diagnosed with significant coronary artery disease on ICA as same as CCTA findings. The per-vessel analysis revealed that 620 (68{\%}) of 916 affected vessels had confirmed concordant significant stenosis between the CCTA and ICA results. The concordance rate was 49{\%} among the segments with identified plaques in the per-segment analysis. Revascularization of the target vessel identified with severe stenosis by CCTA was performed in 228 (35{\%}) patients. A logistic regression analysis revealed that smoking [odds ratio (OR): 1.59, 95{\%} confidence interval (CI): 1.04-2.42, P = 0.03], taller height (OR: 1.02, 95{\%} CI: 1.00-1.05, P = 0.016), and presence of typical symptoms of angina (OR: 1.86, 95{\%} CI: 1.34-2.59, P < 0.001) were found to increase the probability of diagnostic concordance. A greater calcified segment involvement score (OR: 0.88, 95{\%} CI: 0.82-0.94, P < 0.001) was associated with a lower diagnostic concordance. CONCLUSION: The diagnostic discordance between CCTA and ICA was frequently observed in patients who were diagnosed with a CCTA finding of high-grade stenosis.",
author = "Choongki Kim and Hong, {Sung Jin} and Sanghoon Shin and Ahn, {Chul Min} and Kim, {Jung Sun} and Kim, {Byeong Keuk} and Ko, {Young Guk} and Choi, {Byoung Wook} and Donghoon Choi and Yangsoo Jang and Hong, {Myeong Ki}",
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Clinical utility of coronary computed tomography angiography in patients diagnosed with high-grade stenosis of the coronary arteries. / Kim, Choongki; Hong, Sung Jin; Shin, Sanghoon; Ahn, Chul Min; Kim, Jung Sun; Kim, Byeong Keuk; Ko, Young Guk; Choi, Byoung Wook; Choi, Donghoon; Jang, Yangsoo; Hong, Myeong Ki.

In: Coronary artery disease, Vol. 30, No. 7, 01.11.2019, p. 511-519.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical utility of coronary computed tomography angiography in patients diagnosed with high-grade stenosis of the coronary arteries

AU - Kim, Choongki

AU - Hong, Sung Jin

AU - Shin, Sanghoon

AU - Ahn, Chul Min

AU - Kim, Jung Sun

AU - Kim, Byeong Keuk

AU - Ko, Young Guk

AU - Choi, Byoung Wook

AU - Choi, Donghoon

AU - Jang, Yangsoo

AU - Hong, Myeong Ki

PY - 2019/11/1

Y1 - 2019/11/1

N2 - OBJECTIVES: We purposed to evaluate the reliability of coronary computed tomography angiography (CCTA) in patients with a CCTA finding of high-grade stenosis. PATIENTS AND METHODS: Between May 2015 and March 2017, patients who underwent invasive coronary angiography (ICA) because of detection of high-grade stenosis by CCTA ( ≥ 70% stenosis of epicardial arteries or ≥ 50% of the left main coronary artery; Coronary Artery Disease Reporting and Data System grade 4 or 5) were selected for this study from our prospective registry cohort. RESULTS: Among 646 eligible patients, only 263 (41%) patients were correctly diagnosed with significant coronary artery disease on ICA as same as CCTA findings. The per-vessel analysis revealed that 620 (68%) of 916 affected vessels had confirmed concordant significant stenosis between the CCTA and ICA results. The concordance rate was 49% among the segments with identified plaques in the per-segment analysis. Revascularization of the target vessel identified with severe stenosis by CCTA was performed in 228 (35%) patients. A logistic regression analysis revealed that smoking [odds ratio (OR): 1.59, 95% confidence interval (CI): 1.04-2.42, P = 0.03], taller height (OR: 1.02, 95% CI: 1.00-1.05, P = 0.016), and presence of typical symptoms of angina (OR: 1.86, 95% CI: 1.34-2.59, P < 0.001) were found to increase the probability of diagnostic concordance. A greater calcified segment involvement score (OR: 0.88, 95% CI: 0.82-0.94, P < 0.001) was associated with a lower diagnostic concordance. CONCLUSION: The diagnostic discordance between CCTA and ICA was frequently observed in patients who were diagnosed with a CCTA finding of high-grade stenosis.

AB - OBJECTIVES: We purposed to evaluate the reliability of coronary computed tomography angiography (CCTA) in patients with a CCTA finding of high-grade stenosis. PATIENTS AND METHODS: Between May 2015 and March 2017, patients who underwent invasive coronary angiography (ICA) because of detection of high-grade stenosis by CCTA ( ≥ 70% stenosis of epicardial arteries or ≥ 50% of the left main coronary artery; Coronary Artery Disease Reporting and Data System grade 4 or 5) were selected for this study from our prospective registry cohort. RESULTS: Among 646 eligible patients, only 263 (41%) patients were correctly diagnosed with significant coronary artery disease on ICA as same as CCTA findings. The per-vessel analysis revealed that 620 (68%) of 916 affected vessels had confirmed concordant significant stenosis between the CCTA and ICA results. The concordance rate was 49% among the segments with identified plaques in the per-segment analysis. Revascularization of the target vessel identified with severe stenosis by CCTA was performed in 228 (35%) patients. A logistic regression analysis revealed that smoking [odds ratio (OR): 1.59, 95% confidence interval (CI): 1.04-2.42, P = 0.03], taller height (OR: 1.02, 95% CI: 1.00-1.05, P = 0.016), and presence of typical symptoms of angina (OR: 1.86, 95% CI: 1.34-2.59, P < 0.001) were found to increase the probability of diagnostic concordance. A greater calcified segment involvement score (OR: 0.88, 95% CI: 0.82-0.94, P < 0.001) was associated with a lower diagnostic concordance. CONCLUSION: The diagnostic discordance between CCTA and ICA was frequently observed in patients who were diagnosed with a CCTA finding of high-grade stenosis.

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