Key result
The CREDENCE trial is a study protocol designed to determine the diagnostic accuracy of an integrated CCTA metric compared to an integrated MPS measure for the diagnosis of vessel-specific ischemia, with no results available yet.
Why the study?
Does integrated CCTA assessment improve diagnostic accuracy for vessel-specific ischemia compared to integrated MPS assessment in adults with suspected CAD?
Cross-Sectional (n=618)
Masked readers
Yes
Does integrated CCTA assessment improve diagnostic accuracy for vessel-specific ischemia compared to integrated MPS assessment in adults with suspected CAD?
The CREDENCE trial is designed to evaluate whether an integrated CCTA metric (stenosis, plaque characteristics, and FFRCT) provides superior diagnostic accuracy for vessel-specific ischemia compared to integrated MPS, using invasive FFR as the reference standard.
Answers are grounded in this paper and cite their sources.
Integrated CCTA assessment may refine CAD evaluation; leaves open superiority over MPS in clinical practice.
Coronary computed tomography angiography (CCTA) allows for non-invasive assessment of obstructive coronary artery disease (CAD) beyond measures of stenosis severity alone. This assessment includes atherosclerotic plaque characteristics (APCs) and calculation of fractional flow reserve (FFR) from CCTA (FFRCT). Similarly, stress imaging by myocardial perfusion scintigraphy (MPS) provides vital information. To date, the diagnostic performance of integrated CCTA assessment versus integrated MPS assessment for diagnosis of vessel-specific ischemia remains underexplored. CREDENCE will enroll adult individuals with symptoms suspicious of CAD referred for non-emergent invasive coronary angiography (ICA), but without known CAD. All participants will undergo CCTA, MPS, ICA and FFR. FFR will be performed for lesions identified at the time of ICA to be ≥40 and <90 % stenosis, or those clinically indicated for evaluation. Study analyses will focus on diagnostic performance of CCTA versus MPS against invasive FFR reference standard. An integrated stenosis-APC-FFRCT metric by CCTA for vessel-specific ischemia will be developed from derivation cohort and tested against a validation cohort. Similarly, integrated metric by MPS for vessel-specific ischemia will be developed, validated and compared. An FFR value of ≤0.80 will be considered as ischemia causing. The primary endpoint will be the diagnostic accuracy of vessel territory-specific ischemia of integrated stenosis-APC-FFRCT measure by CCTA, compared with perfusion or perfusion–myocardial blood flow stress imaging testing, against invasive FFR. CREDENCE will determine the performance of integrated CCTA metric compared to integrated MPS measure for diagnosis of vessel-specific ischemia. If proven successful, this study may reduce the number of missed diagnoses and help to optimally predict ischemia-causing lesions. ClinicalTrials.gov, NCT02173275 . Registered on June 23, 2014.
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Rizvi et al. (2016) conducted a cross-sectional in Suspected coronary artery disease (n=618). Integrated stenosis-APC-FFRCT measure by CCTA vs. Perfusion or perfusion-MBF stress imaging testing (MPS) was evaluated on Diagnostic accuracy of vessel territory-specific ischemia of integrated stenosis-APC-FFRCT measure by CCTA against invasive FFR. The CREDENCE trial is a study protocol designed to determine the diagnostic accuracy of an integrated CCTA metric compared to an integrated MPS measure for the diagnosis of vessel-specific ischemia, with no results available yet.
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