Clinical Implications of Moderate Coronary Stenosis on Coronary Computed Tomography Angiography in Patients with Stable Angina

• Published in: Yonsei medical journal Vol. 59; no. 8; pp. 937 - 944
• Main Authors: Kim, Choongki, Hong, Sung-Jin, Ahn, Chul-Min, Kim, Jung-Sun, Kim, Byeong-Keuk, Ko, Young-Guk, Choi, Byoung-Wook, Choi, Donghoon, Jang, Yangsoo, Hong, Myeong-Ki
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.10.2018; 연세대학교의과대학
• Subjects: Original; 의학일반; coronary stenosis; computed tomography angiography; Coronary artery disease
• ISSN: 0513-5796; 1976-2437; 1976-2437
• DOI: 10.3349/ymj.2018.59.8.937

The present study investigated the diagnostic accuracy and clinical implications of moderate stenosis (50-69%, Coronary Artery Disease Reporting and Data System, grade 3) on coronary computed tomography angiography (CCTA), compared with invasive coronary angiography (ICA). Two hundred and seventy-six patients who underwent ICA due to moderate stenosis alone on CCTA were selected from our prospective registry cohort. Diagnostic concordance between CCTA and ICA was found in only 50 (18%) patients. Among the 396 vessels and 508 segments with moderate stenosis, diagnostic concordance was found in 132 vessels (33%) and 127 segments (25%). Segments with calcified plaque had lower diagnostic concordance than those with mixed or non-calcified plaque (22% vs. 28% vs. 27%, respectively, =0.001). While calcified plaque burden did not have an influence on severe stenosis (≥70%) on ICA, higher burden of non-calcified plaque was correlated with a greater incidence of ICA-based severe stenosis, which was more frequent in patients with ≥3 segments of non-calcified plaque (75%) than those without non-calcified plaque (22%, <0.001). Typical angina and mixed or non-calcified plaque were correlated with a higher incidence of under-diagnosis, while the use of next-generation computed tomography scanners reduced the incidence of under-diagnosis. Increased body weight, left circumflex artery involvement, and calcified plaque were independent factors that increased the risk of over-diagnosis of CCTA. The diagnosis of moderate stenosis by CCTA may be limited in estimating the exact degree of ICA-based anatomical stenosis. Unlike calcific burden, non-calcific burden was positively correlated with the presence of severe stenosis on ICA.