Coronary CT angiography for the detection of coronary artery stenosis in patients referred for transcatheter aortic valve replacement

• We investigated the diagnostic performance of coronary CT angiography in 115 consecutive patients referred for transcatheter aortic valve replacement.
• Coronary CT angiography with retrospective gating and iterative reconstruction may allow detection of significant stenosis in the proximal or middle segments of coronary arteries and could permit the evaluation of patients after bypass grafts.
• Coronary intervention on distal segments or side branches was performed before or with transcatheter aortic valve replacement in only 2 patients (1.7%).

BackgroundCoronary CT has become the foremost noninvasive imaging modality for detecting coronary stenoses in patients with suspected coronary artery disease. Nevertheless, little is known about its performance in patients undergoing transcatheter aortic valve replacement (TAVR).ObjectiveThis study investigates the diagnostic performance of coronary CT angiography in patients referred for TAVR.MethodsOne hundred and fifteen consecutive patients with severe aortic stenosis underwent CT angiography with retrospective electrocardiography triggered acquisition and an iterative reconstruction algorithm, of whom 23 (20%) had prior coronary artery bypass graft (CABG) surgery. Diagnostic accuracy of CT for detecting significant coronary stenosis (≥50% luminal diameter stenosis in segments ≥2 mm) in the left main, proximal, or middle segments of coronary arteries and bypass grafts was compared with that of invasive coronary angiography.ResultsIn the overall study population, the sensitivity, specificity, and positive and negative predictive value of CT angiography for the detection of coronary segment or bypass graft lesions were 96% (47 of 49), 73% (48 of 66), 72% (47 of 65), and 96% (48 of 50), respectively. The per-patient diagnostic yield of CT angiography was consistent among patients without prior CABG (93% [28 of 30], 73% [45 of 62], 62% [28 of 45], and 96% [45 of 47], respectively) and among patients with prior CABG (100% [19 of 19], 75% [3 of 4], 95% [19 of 20], and 100% [3 of 3], respectively).ConclusionAmong patients referred for TAVR, coronary CT angiography with retrospective gating and iterative reconstruction may allow detection of significant stenosis in the proximal or middle segments of coronary arteries and could permit the evaluation of patients after bypass grafts.