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

Kim, Choongkia,d; Hong, Sung-Jina; Shin, Sanghoond; Ahn, Chul-Mina,b; Kim, Jung-Suna,b; Kim, Byeong-Keuka,b; Ko, Young-Guka,b; Choi, Byoung-Wookc; Choi, Donghoona,b; Jang, Yangsooa,b; Hong, Myeong-Kia,b

doi: 10.1097/MCA.0000000000000750
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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.

aDepartment of Internal Medicine

bCardiovascular Research Institute

cDepartment of Radiology, Yonsei University College of Medicine

dDepartment of Cardiology, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea

Correspondence to Myeong-Ki Hong, MD, PhD, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea Tel: +82 222 288 458; fax: +82 222 277 943; e-mail: mkhong61@yuhs.ac

Received December 20, 2018

Received in revised form December 30, 2018

Accepted March 31, 2019

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