COMPARISON BETWEEN THE DIAGNOSTIC PERFORMANCE OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY AND INVASIVE CORONARY ANGIOGRAPHY IN SYMPTOMATIC CORONARY ARTERY DISEASE PATIENTS ACCORDING TO PATIENT-BASED AND ARTERIAL-BASED ANALYSIS
Keywords:
CAD, CCTA, ICA, Patient-based, arterial-based analysisAbstract
Background: Coronary artery disease (CAD) is the leading cause of death worldwide, patients who present with chest pain of suspected cardiac origin need an accurate and timely diagnostic tool. Although invasive coronary angiography (ICA), is considered to be the gold standard reference in the detection of CAD, however, it is not appropriate for all CAD candidates due to some limitations.
Aim: The present study aims to determine the diagnostic performance of Coronary Computed Tomographic Angiography (CCTA) compared to the invasive coronary angiography (ICA) as a gold standard reference in the diagnosis of significant stenosis (≥ 50%) of coronary artery tree according to patient-based and arterial-based analysis.
methods: This is a single-center observational study conducted at Ibn Al-Bitar Specialized Center for Cardiac Surgery, Baghdad, Iraq on 51 patients (34 males and 17 females) whose ages ranged between (40-82) years, and have undergone CCTA followed by (ICA) within a mean interval of (38.75 days). The study was carried out during the period from February 2022 to December 2023. The selected patients included those who present with chest pain suspected to have CAD that underwent CCTA using Philips Brilliance 64-slice CT scanner .
Results: In this study, of the 51 participants, 34 (66.7%) were males, and 17 (30.3%) were female, 41 patients were hypertensive, 8 were diabetic, 36 were smokers, 38 had dyslipidemia, 33 had typical chest pain, 11 had atypical chest pain and 7 had angina pain.
Conclusion: The diagnostic performance and accuracy of CCTA in comparison with ICA according to patient-based and arterial based analysis is valued to be high in the detection or exclusion of significant CAD.
References
1. Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2019). Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 139(10), e56-e528.
2. Xu, Y., Tang, L., Zhu, X., Xu, H., Tang, J., Yang, Z., ... & Wang, D. (2010). Comparison of dual-source CT coronary angiography and conventional coronary angiography for detecting coronary artery disease. The international journal of cardiovascular imaging, 26, 75-81.
3. Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Blaha, M. J., ... & Fullerton, H. J. (2013). AHA statistical update. Circulation, 127, e62-e245.
4. Fihn, S. D., Gardin, J. M., Abrams, J., Berra, K., Blankenship, J. C., Dallas, A. P., (2012). 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 126(25), e354-e471.
5. Smuclovisky, C. Introduction. In: Smuclovisky, C. (eds) Coronary Artery CTA 2018 (pp. 1-4). Springer, Cham. https://doi.org/10.1007/978-3-319-66988-5-1.
6. Litt HI, Gatsonis C, Snyder B, Singh H, Miller CD, Entrikin DW. CT angiography for safe discharge of patients with possible acute coronary syndromes. New England Journal of Medicine. 2012 Apr 12;366(15):1393-403.
7. Agliata G, Schicchi N, Agostini A et al (2019) Radiation exposure related to cardiovascular CT examination: comparison between conventional 64-MDCT and third-generation dual-source MDCT. Radiol Med 124:753–761.
8. Kelion AD, Nicol ED. The rationale for the primacy of coronary CT angiography in the National Institute for Health and Care Excellence (NICE) guideline (CG95) for the investigation of chest pain of recent onset. Journal of cardiovascular computed tomography. 2018 Nov 1;12(6):516-22.
9. Roberts, W., Charles, S. M., Ang, C., Holda, M. K., Walocha, J., Lachman, N. (2021). Myocardial bridges: A meta‐analysis. Clinical anatomy, 34(5), 685-709.
10. Sajjadieh, A., Hekmatnia, A., Keivani, M., Asoodeh, A., Pourmoghaddas, M., & Sanei, H. (2013). Diagnostic performance of 64-row coronary CT angiography in detecting significant stenosis as compared with conventional invasive coronary angiography. ARYA atherosclerosis, 9(2), 157.
11. ŞAHİN, M., GÖRMELİ, C. A., Nurullah, D. A. Ğ., & Fuat, K. U. R. T. (2021). Comparison of Multi-Detector Computed Tomography Coronary Angiography with Invasive Coronary Angiography in Patients with Coronary Artery Disease. Medical Records, 3(3), 164-170.
12. Baykiz, D, Govdeli, EA., Demirtakan ZG., Karaayvaz, EB Elitok, A., Dursun, M. (2022). the diagnostic performance of coronary computed tomographic angiography compared with invasive coronary angiography in symptomatic patients: long–term prognostic implications. Journal of Istanbul Faculty of Medicine, 85(3), 322-343.
13. Iwasaki, K., & Matsumoto, T. (2016). Relationship between coronary calcium score and high-risk plaque/significant stenosis. World Journal of Cardiology, 8(8), 481.
14. Mannan, M., Bashar, M. A., Mohammad, J., Jahan, M. U., Momenuzzaman, N. A., & Haque, M. A. (2014). Comparison of coronary CT angiography with conventional coronary angiography in the diagnosis of coronary artery disease. Bangladesh Medical Research Council Bulletin, 40(1), 31-35.
15. Pursnani, A., Chou, E. T., Zakroysky, P., Deaño, R. C., Mamuya, W. S., Woodard, P. K. (2015). Use of coronary artery calcium scanning beyond coronary computed tomographic angiography in the emergency department evaluation for acute chest pain: the ROMICAT II trial. Circulation: Cardiovascular Imaging, 8(3), e002225.
16. Chao, S. P., Law, W. Y., Kuo, C. J., Hung, H. F., Cheng, J. J., Lo, H. M. (2010). The diagnostic accuracy of 256-row computed tomographic angiography compared with invasive coronary angiography in patients with suspected coronary artery disease. European heart journal, 31(15), 1916-1923.
