Key result
Pre-TAVI computed tomography angiography demonstrated a high negative predictive value of 97.5% at the vessel level for excluding significant coronary artery disease.
Why the study?
Computed tomography angiography is used to plan TAVI procedures, but its performance for excluding coronary artery disease required investigation.
Does pre-TAVI Computed Tomography Angiography (CTA) accurately exclude coronary artery disease compared to invasive coronary angiography in patients undergoing TAVI?
Cohort (n=127)
Blinded to reference standard (ICA) images and reports
No
Does pre-TAVI Computed Tomography Angiography (CTA) accurately exclude coronary artery disease compared to invasive coronary angiography in patients undergoing TAVI?
Effect estimate: 97.5%
Pre-TAVI CTA demonstrates a high negative predictive value for excluding significant coronary artery disease, suggesting it can effectively serve as a non-invasive gatekeeper to invasive coronary angiography.
May support CTA to exclude proximal CAD pre-TAVI; leaves open whether it can safely defer ICA in routine practice.
BACKGROUND: Computed tomography angiography (CTA) is used to plan TAVI procedures. We investigated the performance of pre-TAVI CTA for excluding coronary artery disease (CAD). METHODS: In total 127 patients were included. CTA images were analyzed for the presence of ≥ 50% (significant CAD) and ≥ 70% (severe CAD) diameter stenoses in proximal coronary arteries. Results were compared with invasive coronary angiography (ICA) at vessel and patient levels. Primary endpoint was the negative predictive value (NPV) of CTA for the presence of CAD. RESULTS: A total of 342 vessels were analyzable. NPV of CTA was 97.5% for significant CAD and 96.3% for severe CAD. Positive predictive value and accuracy were 44.8% and 87.1% for significant CAD and 56.3% and 94.4% for severe CAD. At patient level, NPV for significant CAD was 88.6%. CONCLUSION: Pre-TAVI CTA shows good performance for ruling out CAD and could be used as a gatekeeper for ICA in selected patients.
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Meier et al. (2021) conducted a cohort in Coronary Artery Disease in patients undergoing Transcatheter Aortic Valve Implantation (n=127). Computed Tomography Angiography (CTA) vs. Invasive Coronary Angiography (ICA) was evaluated on Negative predictive value (NPV) of CTA for the presence of significant CAD (≥ 50% diameter stenosis) (97.5%). Pre-TAVI computed tomography angiography demonstrated a high negative predictive value of 97.5% at the vessel level for excluding significant coronary artery disease.
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