Coronary computed tomographic angiography does not accurately predict the need of coronary revascularization in patients with stable angina

Sung Jin Hong, Ae Young Her, Yongsung Suh, Hoyoun Won, Deok Kyu Cho, Yun Hyeong Cho, Young Won Yoon, Kyounghoon Lee, Woong Chol Kang, Yong Hoon Kim, Sang Wook Kim, Dong Ho Shin, Jung Sun Kim, Byeong Keuk Kim, Young Guk Ko, Byoung Wook Choi, Donghoon Choi, Yangsoo Jang, Myeong Ki Hong

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Abstract

Purpose: To evaluate the ability of coronary computed tomographic angiography (CCTA) to predict the need of coronary revascularization in symptomatic patients with stable angina who were referred to a cardiac catheterization laboratory for coronary revascularization. Materials and Methods: Pre-angiography CCTA findings were analyzed in 1846 consecutive symptomatic patients with stable angina, who were referred to a cardiac catheterization laboratory at six hospitals and were potential candidates for coronary revascularization between July 2011 and December 2013. The number of patients requiring revascularization was determined based on the severity of coronary stenosis as assessed by CCTA. This was compared to the actual number of revascularization procedures performed in the cardiac catheterization laboratory. Results: Based on CCTA findings, coronary revascularization was indicated in 877 (48%) and not indicated in 969 (52%) patients. Of the 877 patients indicated for revascularization by CCTA, only 600 (68%) underwent the procedure, whereas 285 (29%) of the 969 patients not indicated for revascularization, as assessed by CCTA, underwent the procedure. When the coronary arteries were divided into 15 segments using the American Heart Association coronary tree model, the sensitivity, specificity, positive predictive value, and negative predictive value of CCTA for therapeutic decision making on a per-segment analysis were 42%, 96%, 40%, and 96%, respectively. Conclusion: CCTA-based assessment of coronary stenosis severity does not sufficiently differentiate between coronary segments requiring revascularization versus those not requiring revascularization. Conventional coronary angiography should be considered to determine the need of revascularization in symptomatic patients with stable angina.

Original languageEnglish
Pages (from-to)1079-1086
Number of pages8
JournalYonsei medical journal
Volume57
Issue number5
DOIs
Publication statusPublished - 2016 Sep

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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    Hong, S. J., Her, A. Y., Suh, Y., Won, H., Cho, D. K., Cho, Y. H., Yoon, Y. W., Lee, K., Kang, W. C., Kim, Y. H., Kim, S. W., Shin, D. H., Kim, J. S., Kim, B. K., Ko, Y. G., Choi, B. W., Choi, D., Jang, Y., & Hong, M. K. (2016). Coronary computed tomographic angiography does not accurately predict the need of coronary revascularization in patients with stable angina. Yonsei medical journal, 57(5), 1079-1086. https://doi.org/10.3349/ymj.2016.57.5.1079