Yonsei Med J.  2018 Oct;59(8):937-944. 10.3349/ymj.2018.59.8.937.

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

• Kim C
• Hong SJ
• Ahn CM
• Kim JS
• Kim BK
• Ko YG
• Choi BW
• Choi D
• Jang Y
• Hong MK

• KMID: 2419727
• DOI: http://doi.org/10.3349/ymj.2018.59.8.937

Abstract

PURPOSE
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).
MATERIALS AND METHODS
Two hundred and seventy-six patients who underwent ICA due to moderate stenosis alone on CCTA were selected from our prospective registry cohort.
RESULTS
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, p=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%, p < 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.
CONCLUSION
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.

Keyword

Coronary artery disease; coronary stenosis; computed tomography angiography

MeSH Terms

Angina, Stable*
Angiography*
Arteries
Body Weight
Cohort Studies
Constriction, Pathologic
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis*
Diagnosis
Humans
Incidence
Information Systems
Prospective Studies

Figure

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  Fig. 1 Study flow. CAD-RADS, Coronary Artery Disease Reporting and Data System; CCTA, coronary computed tomography angiography; ICA, invasive coronary angiography.

• 

  Fig. 2 Diagnostic correlation between CCTA and ICA per patient analysis. (A) Diagnostic accuracy. (B) Degree of maximal stenosis. CCTA, coronary computed tomography angiography; ICA, invasive coronary angiography; VD, vessel disease.

• 

  Fig. 3 Presence of any significant stenosis in patients according to plaque burden. Patients were categorized by quartiles of non-calcified (A) and calcified (B) SIS, and calcium score (C). CT, computed tomography; SIS, segment involvement score; ICA, invasive coronary angiography.

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