Discrepancies between coronary CT angiography and invasive coronary angiography with focus on culprit lesions which cause future cardiac events
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To evaluate the clinical significance of discrepant lesions between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) in a longitudinal study.
In 220 patients with suspected coronary artery disease (CAD) who underwent both 256-row CCTA and ICA, the obstructive CAD (≥ 50% stenosis) on CCTA was compared with that on ICA as the reference standard. We analysed the causes of the discrepancy between CCTA and ICA. During a 40-month follow-up period, major adverse cardiac events (MACE) were assessed.
Discordance between CCTA and ICA was observed in 121 of the 3166 coronary artery segments (3.8%). Common causes were calcification (45.9%) and positive remodelling (PR) (29.6%) in 83 false positive lesions, and noise (40.0%) and motion artefact (37.8%) in 38 false negative lesions. MACE occurred in seven lesions among the discrepant lesions; six among the 29 PR lesions (20.7%) and one among the 53 calcified lesions (1.9%). With respect to the prediction power of MACE in an intermediate stenosis, the CCTA-related value including PR was higher than the ICA-related value.
PR was a frequent cause of MACE among the false positive lesions on CCTA. Therefore, the presence of PR on CCTA may suggest clinical significance, although it can be missed by ICA.
• Compared to ICA, PR in CCTA may be cause of false positive lesion.
• CCTA-related value including PR shows higher prediction power of MACE than ICA-related value.
• PR reflects atherosclerotic burden that can be related to cardiac events.
• PR in CCTA should be observed carefully, even if it is false positive.
KeywordsCoronary artery disease Computed tomography angiography Atherosclerotic plaque Coronary stenosis Acute coronary syndrome
Compliance with ethical standards
The scientific guarantor of this publication is Kyung Won Lee, MD, PhD.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
This study has received funding from the Seoul National University Bundang Hospital (SNUBH) (research grant no. 02-2015-044) and by the National Research Foundation (NRF) grant funded by the Korea government (MEST) (NRF-2015R1D1A1A01059717).
Statistics and biometry
One of the authors has significant statistical expertise.
No complex statistical methods were necessary for this paper.
Institutional review board approval was obtained.
Written informed consent was waived by the institutional review board.
• diagnostic or prognostic study
• performed at one institution
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