Computed tomography coronary angiography demonstrates 90-97% sensitivity and 94-99% negative predictive value for excluding significant proximal coronary artery disease in TAVI candidates.
Can computed tomography coronary angiography serve as a reliable gatekeeper to avoid unnecessary invasive coronary angiography in TAVI candidates?
CTCA can serve as a reliable first-line screening tool to exclude significant proximal coronary artery disease and avoid unnecessary invasive coronary angiography prior to TAVI.
Absolute Event Rate: 0% vs 0%
Transcatheter aortic valve implantation (TAVI) has become the predominant treatment strategy for severe aortic stenosis across all surgical risk categories. The coexistence of coronary artery disease (CAD) in 40–75% of TAVI candidates has traditionally mandated pre-procedural invasive coronary angiography (ICA). However, computed tomography coronary angiography (CTCA), which is already integral to TAVI planning for annular sizing and access route evaluation, offers the potential to assess coronary anatomy simultaneously. Accumulating evidence demonstrates that CTCA possesses excellent sensitivity (90–97%) and high negative predictive value (94–99%) for excluding significant proximal CAD, potentially serving as a reliable gatekeeper to avoid unnecessary ICA in a substantial proportion of patients. This approach is particularly attractive given the questionable benefit of routine pre-emptive coronary revascularization in stable TAVI candidates, as demonstrated by the ACTIVATION and NOTION-3 trials. This review synthesizes the current evidence on the diagnostic performance of CTCA, clinical outcomes with CT-guided strategies, technical considerations and limitations, and the evolving paradigm of coronary assessment in the contemporary TAVI era. We propose a practical algorithm integrating CTCA as a first-line screening tool, reserving ICA for patients with suspected significant proximal disease, thereby optimizing resource utilization while maintaining patient safety.
Apostolos et al. (Wed,) reported a other. Computed tomography coronary angiography demonstrates 90-97% sensitivity and 94-99% negative predictive value for excluding significant proximal coronary artery disease in TAVI candidates.