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KMID : 0311120180590080937
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Yonsei Medical Journal
2018 Volume.59 No. 8 p.937 ~ p.944
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Clinical Implications of Moderate Coronary Stenosis on Coronary Computed Tomography Angiography in Patients with Stable Angina
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Kim Choong-Ki
Hong Sung-Jin
Ahn Chul-Min
Kim Jung-Sun
Kim Byeong-Keuk
Ko Young-Guk
Choi Byoung-Wook
Choi Dong-Hoon
Jang Yang-Soo
Hong Myeong-Ki
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Abstract
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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.
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KEYWORD
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Coronary artery disease, coronary stenosis, computed tomography angiography
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