Key result
Coronary CTA increases detection of relevant extracardiac findings ~13-fold compared with ICA in suspected CAD.
Why the study?
The detection of clinically relevant extracardiac findings on coronary computed tomography angiography compared to invasive coronary angiography and their potential clinical benefit was unclear.
Does coronary computed tomography angiography detect more clinically relevant extracardiac findings compared to invasive coronary angiography in patients with atypical angina and suspected CAD?
RCT (n=329)
Randomized
No
Does coronary computed tomography angiography detect more clinically relevant extracardiac findings compared to invasive coronary angiography in patients with atypical angina and suspected CAD?
Absolute Event Rate: 32.9% vs 2.5%
p-value: p=<0.001
CTA detects significantly more clinically relevant extracardiac findings than ICA, which may explain atypical chest pain and alter patient management in patients without CAD.
May prompt extracardiac review on CTA to explain atypical angina; extends RCT evidence versus ICA for comprehensive CAD evaluation.
OBJECTIVES: To compare the detection of relevant extracardiac findings (ECFs) on coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA) and evaluate the potential clinical benefit of their detection. METHODS: This is the prespecified subanalysis of ECFs in patients presenting with a clinical indication for ICA based on atypical angina and suspected coronary artery disease (CAD) included in the prospective single-center randomized controlled Coronary Artery Disease Management (CAD-Man) study. ECFs requiring immediate therapy and/or further workup including additional imaging were defined as clinically relevant. We evaluated the scope of ECFs in 329 patients and analyzed the potential clinical benefit of their detection. RESULTS: ECFs were detected in 107 of 329 patients (32.5%; CTA: 101/167, 60.5%; ICA: 6/162, 3.7%; p < .001). Fifty-nine patients had clinically relevant ECFs (17.9%; CTA: 55/167, 32.9%; ICA: 4/162, 2.5%; p < .001). In the CTA group, ECFs potentially explained atypical chest pain in 13 of 101 patients with ECFs (12.9%). After initiation of therapy, chest pain improved in 4 (4.0%) and resolved in 7 patients (6.9%). Follow-up imaging was recommended in 33 (10.0%; CTA: 30/167, 18.0%; ICA: 3/162, 1.9%) and additional clinic consultation in 26 patients (7.9%; CTA: 25/167, 15.0%; ICA: 1/162, 0.6%). Malignancy was newly diagnosed in one patient (0.3%; CTA: 1/167, 0.6%; ICA: 0). CONCLUSIONS: In this randomized study, CTA but not ICA detected clinically relevant ECFs that may point to possible other causes of chest pain in patients without CAD. Thus, CTA might preclude the need for ICA in those patients. TRIAL REGISTRATION: NCT Unique ID: 00844220 KEY POINTS: • CTA detects ten times more clinically relevant ECFs than ICA. • Actionable clinically relevant ECFs affect patient management and therapy and may thus improve chest pain. • Detection of ECFs explaining chest pain on CTA might preclude the need for performing ICA.
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Laskowski et al. (2021) conducted an RCT in Atypical angina and suspected coronary artery disease (n=329). Coronary computed tomography angiography (CTA) vs. Invasive coronary angiography (ICA) was evaluated on Detection of clinically relevant extracardiac findings (ECFs) (p=<0.001). Coronary computed tomography angiography detected significantly more clinically relevant extracardiac findings than invasive coronary angiography (32.9% vs 2.5%, p < 0.001) in patients with suspected CAD.
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