CCTA-Guided Selective Invasive Coronary Catheterization: A Strategy to Reduce Contrast Volume and Improve Efficiency
Abstract
:1. Introduction
2. Methods
2.1. Design and Study Population
2.2. Coronary Computed Tomography Angiography
2.3. Invasive Coronary Angiography
2.4. Procedural Characteristics of the Unilateral ICA Visualization Strategy
2.5. Statistical Analysis
3. Results
3.1. CCTA’s Performance in Excluding Significant CAD
3.2. Procedural Time and Contrast Use Following a CCTA-Guided Unilateral Visualization Strategy
4. Discussion
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CAD | Coronary Artery Disease |
ICA | Invasive Coronary Angiography |
LCA | Left Coronary Artery |
RCA | Right Coronary Artery |
CCTA | Coronary Computed Tomography Angiography |
DS | Diameter Stenosis |
FFR | Fractional Flow Reserve |
TN | True Negative |
FN | False Negative |
PCI | Coronary Percutaneous Intervention |
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Variables | |
---|---|
Age in years (mean ± SD) | 61 ± 9 |
Male sex (%) | 129 (68%) |
Diabetes mellitus (%) | 28 (15%) |
Hypertension (%) | 91 (48%) |
Hypercholesterolemia (%) | 69 (35%) |
Current smoker (%) | 21 (11%) |
Previous CAD (%) | 3 (1.6%) |
BMI (mean ± SD) | 26.4 ± 4 |
CCTA features | |
Obstructive CAD side DS% | |
50–69% | 50 (26%) |
70–99% | 87 (46%) |
100% | 10 (5%) |
Non-diagnostic | 43 (23%) |
Non-obstructive CAD side DS% | |
0% | 64 (34%) |
1–24% | 84 (44%) |
25–49% | 42 (22%) |
Absence of Hemodynamically Significant CAD | Hemodynamically Significant CAD | ||
---|---|---|---|
CCTA | Absence of Obstructive CAD (<50% DS) | 185 (97.4%, 95% CI: 94–99) | 5 (2.6%, 95% CI: 1–6) |
True Negatives | False Negatives |
True Negative (n = 185 Patients) | False Negative (n = 5 Patients) | p-Value | |
---|---|---|---|
Age in years (mean ± SD) | 60.5 ± 9 | 62.2 ± 12 | 0.69 |
Male sex (%) | 122 (66%) | 5 (100%) | 0.11 |
Diabetes mellitus (%) | 27 (32%) | 1 (20%) | 0.93 |
Hypertension (%) | 87 (46%) | 4 (80%) | 0.35 |
Hypercholesterolemia (%) | 61 (37%) | 4 (80%) | 0.72 |
Smoking history (%) | 21 (11%) | 0 (0%) | 0.51 |
Previous CAD (%) | 3 (2%) | 0 (0%) | 0.77 |
BMI (mean ± SD) | 26 ± 4 | 29 ± 9 | 0.08 |
CCTA characteristics | |||
Artery with non-obstructive CAD | |||
RCA (%) | 154 (83%) | 5 (100%) | 0.32 |
LCA (%) | 31 (17%) | 0 (0%) | |
Artery with non-obstructive CAD | |||
25–49 DS% | 41 (22%) | 1 (20%) | 0.19 |
1–24 DS% | 80 (43%) | 4 (80%) | |
0 DS% | 64 (35%) | 0 (0%) | |
Invasive measurements | |||
FFR (mean ± SD) | 0.94 ± 0.06 | 0.61 | <0.01 |
Absence of Hemodynamically Significant CAD | Hemodynamically Significant CAD | ||
---|---|---|---|
CCTA | Absence of Obstructive CAD (0% DS) | 64 (100%, 95% CI: 94–100) | 0 (0%, 95% CI: 0–6) |
True Negatives | False Negatives |
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Dahdal, J.; Jukema, R.; Somsen, A.G.; Kooijman, E.; Wahedi, E.; Lemkes, J.S.; Raijmakers, P.G.; Heestermans, T.; van Royen, N.; Knaapen, P.; et al. CCTA-Guided Selective Invasive Coronary Catheterization: A Strategy to Reduce Contrast Volume and Improve Efficiency. Diagnostics 2025, 15, 890. https://doi.org/10.3390/diagnostics15070890
Dahdal J, Jukema R, Somsen AG, Kooijman E, Wahedi E, Lemkes JS, Raijmakers PG, Heestermans T, van Royen N, Knaapen P, et al. CCTA-Guided Selective Invasive Coronary Catheterization: A Strategy to Reduce Contrast Volume and Improve Efficiency. Diagnostics. 2025; 15(7):890. https://doi.org/10.3390/diagnostics15070890
Chicago/Turabian StyleDahdal, Jorge, Ruurt Jukema, Aernout G. Somsen, Eline Kooijman, Ellaha Wahedi, Jorrit S. Lemkes, Pieter G. Raijmakers, Ton Heestermans, Niels van Royen, Paul Knaapen, and et al. 2025. "CCTA-Guided Selective Invasive Coronary Catheterization: A Strategy to Reduce Contrast Volume and Improve Efficiency" Diagnostics 15, no. 7: 890. https://doi.org/10.3390/diagnostics15070890
APA StyleDahdal, J., Jukema, R., Somsen, A. G., Kooijman, E., Wahedi, E., Lemkes, J. S., Raijmakers, P. G., Heestermans, T., van Royen, N., Knaapen, P., & Danad, I. (2025). CCTA-Guided Selective Invasive Coronary Catheterization: A Strategy to Reduce Contrast Volume and Improve Efficiency. Diagnostics, 15(7), 890. https://doi.org/10.3390/diagnostics15070890