Diagnostic Performance and Clinical Impact of Photon-Counting Detector Computed Tomography in Coronary Artery Disease
Key result
Photon-counting detector CT linked to ~24% fewer invasive coronary angiography referrals vs conventional CT.
- P<0.001
- n=7,833
Why the study?
Photon-counting detector computed tomography (PCD-CT) is a promising technology with improved spatial resolution, but its clinical impact and diagnostic performance versus conventional energy-integrating detector CT (EID-CT) for obstructive CAD needed evaluation.
Does photon-counting detector-computed tomography (PCD-CT) improve diagnostic performance and clinical impact compared to conventional energy-integrating detector computed tomography (EID-CT) in patients undergoing clinically indicated CCTA?
Study Design
Type
Cohort (n=7,833)
Blinding
Blinded assessment
Multicenter
No
Structured PICO
Does photon-counting detector-computed tomography (PCD-CT) improve diagnostic performance and clinical impact compared to conventional energy-integrating detector computed tomography (EID-CT) in patients undergoing clinically indicated CCTA?
P
Population
7,833 consecutive patients undergoing clinically indicated coronary computed tomography angiography at a single center.
E
Exposure
Photon-counting detector-computed tomography (PCD-CT) (n = 3,876)
C
Comparator
Conventional energy-integrating detector computed tomography (EID-CT) (n = 3,957)
O
Outcome
Diagnostic performance (specificity, sensitivity, positive predictive value, negative predictive value, diagnostic accuracy) for obstructive CAD using quantitative coronary angiography as the reference standard, and clinical impact (referral to invasive coronary angiography and subsequent revascularization).surrogate
Main Result
Absolute Event Rate: 9.9% vs 13.1%
p-value: p=<0.001
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“I think the future of interventional cardiology is photon-counting CT along with CT-guided PCI.”
AJAndrew J. EinsteinCardiologist, Columbia University
“This reduction was particularly marked for patients with a coronary artery calcium score >400 Agatston units, for which the absolute reduction of 9% translates to a number needed to prevent of 11—for every 11 patients with a high calcium score undergoing CCTA, unnecessary ICA would be prevented in 1 by using PCD-CT rather than EID-CT. Given the inherent costs and risks of ICA, including major adverse cardiac and cerebrovascular events in close to 1 in 1,000 procedures, even in high-quality catheterization laboratories, this ability of PCD-CT to prevent unnecessary ICAs is extremely important.”
PSPrabhakar Shantha RajiahRadiologist, Mayo Clinic
“Sakai et al. reported in a cohort of 7,833 patients that PCCT was associated with fewer referrals to invasive coronary angiography (9.9% vs. 13.1%), lower rates of unnecessary angiography (5.6% vs. 8.4%), and higher revascularization rates among those referred (43.4% vs. 35.5%).”
Implication
PCD-CT improves diagnostic accuracy for obstructive CAD compared to conventional EID-CT, reducing unnecessary invasive angiograms while increasing the yield of appropriate revascularizations.
Abstract
BACKGROUND Photon-counting detector-computed tomography (PCD-CT) has emerged as a promising technology, offering improved spatial resolution. OBJECTIVES This study aimed to evaluate the clinical impact and diagnostic performance of PCD-CT vs conventional energy-integrating detector computed tomography (EID-CT) for obstructive coronary artery disease (CAD). METHODS From 2022 to 2023, we retrospectively identified 7,833 consecutive patients who underwent clinically indicated coronary computed tomography angiography (CCTA) at a single center, with either PCD-CT (n = 3,876; NAEOTOM Alpha [Siemens Healthineers]) or EID-CT (n = 3,957; Revolution Apex 256 [GE HealthCare] or Aquilion ONE ViSION 320 [Canon Medical Systems]) scanners. Subsequent invasive coronary angiography (ICA) and percutaneous or surgical revascularization were performed as part of routine clinical care. Among those referred for ICA after coronary CTA, the presence of obstructive CAD in each vessel was determined by coronary CTA (severe stenosis on visual assessment per the Coronary Artery Disease Reporting and Data System) and ICA (≥50% diameter stenosis on quantitative coronary angiography) in a blinded fashion. The diagnostic performance of EID-CT and PCD-CT was compared by using quantitative coronary angiography as the reference standard. RESULTS Patients who underwent PCD-CT were less frequently referred to subsequent ICA than those undergoing EID-CT (9.9% vs 13.1%; P < 0.001). Among those who underwent ICA, revascularization was more frequently performed in the PCD-CT group than in the EID-CT group (43.4% vs 35.5%; P = 0.02). In the vessel-level analysis (n = 1,686), specificity (98.0% vs 93.0%; P < 0.001), positive predictive value (83.3% vs 63.0%; P = 0.002), and diagnostic accuracy (97.2% vs 92.8%; P < 0.001) were improved by PCD-CT. Sensitivity (90.9% vs 90.7%; P = 0.95) and negative predictive value (98.9% vs 98.7%; P = 0.83) for obstructive CAD were similar between the PCD-CT and EID-CT groups, respectively. CONCLUSIONS PCD-CT exhibited excellent diagnostic performance for detecting obstructive CAD. Compared with patients undergoing conventional EID-CT, fewer patients were referred to ICA after PCD-CT, but those referred were more likely to undergo revascularization.
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Cite This Study
Sakai et al. (2024) conducted a cohort in Coronary artery disease (n=7,833). Photon-counting detector computed tomography (PCD-CT) vs. Energy-integrating detector computed tomography (EID-CT) was evaluated on Referral to subsequent invasive coronary angiography (ICA) (p=<0.001). Photon-counting detector CT was associated with fewer referrals to invasive coronary angiography compared to conventional CT (9.9% vs 13.1%; P<0.001) and improved diagnostic specificity.