Diagnostic accuracy of high-definition CT coronary angiography in high-risk patients

•Diagnostic accuracy of High-Definition CT Angiography (HD-CTCA) has been assessed.•Invasive Coronary angiography (ICA) is the reference standard.•Diagnostic accuracy of HD-CTCA is comparable to ICA.•Diagnostic accuracy is not affected by coronary calcium or stents.•HD-CTCA provides a non-invasive alternative in high-risk patients.

AimTo assess the diagnostic accuracy of computed tomography coronary angiography (CTCA) using a combination of high-definition CT (HD-CTCA) and high level of reader experience, with invasive coronary angiography (ICA) as the reference standard, in high-risk patients for the investigation of coronary artery disease (CAD).Materials and methodsThree hundred high-risk patients underwent HD-CTCA and ICA. Independent experts evaluated the images for the presence of significant CAD, defined primarily as the presence of moderate (≥50%) stenosis and secondarily as the presence of severe (≥70%) stenosis in at least one coronary segment, in a blinded fashion. HD-CTCA was compared to ICA as the reference standard.ResultsNo patients were excluded. Two hundred and six patients (69%) had moderate and 178 (59%) had severe stenosis in at least one vessel at ICA. The sensitivity, specificity, positive predictive value, and negative predictive value were 97.1%, 97.9%, 99% and 93.9% for moderate stenosis, and 98.9%, 93.4%, 95.7% and 98.3%, for severe stenosis, on a per-patient basis.ConclusionThe combination of HD-CTCA and experienced readers applied to a high-risk population, results in high diagnostic accuracy comparable to ICA. Modern generation CT systems in experienced hands might be considered for an expanded role.