Computed tomography coronary angiography demonstrated a pooled sensitivity of 95.3% and a negative predictive value of 94.0% for detecting significant coronary artery disease in TAVI candidates.
Systematic Review (n=1,275)
Does computed tomography coronary angiography (CTCA) accurately detect significant coronary artery disease compared to invasive coronary angiography in TAVI candidates?
CTCA provides high sensitivity and negative predictive value for excluding significant coronary artery disease in TAVI candidates, potentially reducing the need for routine invasive coronary angiography by 37%.
Effect estimate: Sensitivity 95.3% (95% CI 93.3-96.9)
Transcatheter aortic valve implantation (TAVI) has evolved to standard treatment of severe aortic stenosis in patients with an intermediate to high surgical risk. Computed tomography coronary angiography (CTCA) could partially replace invasive coronary angiography to diagnose significant coronary artery disease in the work-up for TAVI. A literature search was performed in MEDLINE and EMBASE for papers comparing CTCA and coronary angiography in TAVI candidates. The primary endpoint was the diagnostic accuracy of CTCA, compared to coronary angiography, for detection of significant (>50% diameter stenosis) coronary artery disease, measured as sensitivity, specificity, positive-(PPV) and negative predictive value (NPV). Seven studies were included, with a cumulative sample size of 1,275 patients. The patient-based pooled sensitivity, specificity, PPV and NPV were 95, 65, 71 and 94% respectively. Quality assessment revealed excellent and good quality in terms of applicability and risk of bias respectively, with the main concern being patient selection. In conclusion, on the basis of a significance cut-off value of 50% diameter stenosis, CTCA provides acceptable diagnostic accuracy for the exclusion of coronary artery disease in patients referred for TAVI. Using the routinely performed preoperative computed tomography scans as a gatekeeper for coronary angiography could decrease additional coronary angiographies by 37% in this high-risk and fragile population.
Boogert et al. (Mon,) conducted a systematic review in Severe aortic stenosis in patients referred for TAVI (n=1,275). Computed tomography coronary angiography (CTCA) vs. Invasive coronary angiography was evaluated on Diagnostic accuracy (sensitivity) of CTCA for detection of significant (>50% diameter stenosis) coronary artery disease (Sensitivity 95.3%, 95% CI 93.3-96.9). Computed tomography coronary angiography demonstrated a pooled sensitivity of 95.3% and a negative predictive value of 94.0% for detecting significant coronary artery disease in TAVI candidates.