TY - JOUR
T1 - CTCA for detection of significant coronary artery disease in routine TAVI work-up
T2 - A systematic review and meta-analysis
AU - van den Boogert, T. P.W.
AU - Vendrik, J.
AU - Claessen, B. E.P.M.
AU - Baan, J.
AU - Beijk, M. A.
AU - Limpens, J.
AU - Boekholdt, S. A.M.
AU - Hoek, R.
AU - Planken, R. N.
AU - Henriques, J. P.
N1 - Funding Information:
Conflict of Interest J. Baan Jr. receives an unrestricted research grant from Edwards Lifesciences and is proctor for Edwards Lifesciences. T.P.W. van den Boogert, J. Vendrik, B.E.P.M. Claessen, M.A. Beijk, J. Limpens, S.A.M. Boekholdt, R. Hoek, R.N. Planken and J.P. Henriques declare that they have no competing interests.
Publisher Copyright:
© 2018, The Author(s).
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Transcatheter aortic valve implantation (TAVI) has evolved to standard treatment of severe aortic stenosis in patients with an intermediate to high surgical risk. Computed tomography coronary angiography (CTCA) could partially replace invasive coronary angiography to diagnose significant coronary artery disease in the work-up for TAVI. A literature search was performed in MEDLINE and EMBASE for papers comparing CTCA and coronary angiography in TAVI candidates. The primary endpoint was the diagnostic accuracy of CTCA, compared to coronary angiography, for detection of significant (>50% diameter stenosis) coronary artery disease, measured as sensitivity, specificity, positive—(PPV) and negative predictive value (NPV). Seven studies were included, with a cumulative sample size of 1,275 patients. The patient-based pooled sensitivity, specificity, PPV and NPV were 95, 65, 71 and 94% respectively. Quality assessment revealed excellent and good quality in terms of applicability and risk of bias respectively, with the main concern being patient selection. In conclusion, on the basis of a significance cut-off value of 50% diameter stenosis, CTCA provides acceptable diagnostic accuracy for the exclusion of coronary artery disease in patients referred for TAVI. Using the routinely performed preoperative computed tomography scans as a gatekeeper for coronary angiography could decrease additional coronary angiographies by 37% in this high-risk and fragile population.
AB - Transcatheter aortic valve implantation (TAVI) has evolved to standard treatment of severe aortic stenosis in patients with an intermediate to high surgical risk. Computed tomography coronary angiography (CTCA) could partially replace invasive coronary angiography to diagnose significant coronary artery disease in the work-up for TAVI. A literature search was performed in MEDLINE and EMBASE for papers comparing CTCA and coronary angiography in TAVI candidates. The primary endpoint was the diagnostic accuracy of CTCA, compared to coronary angiography, for detection of significant (>50% diameter stenosis) coronary artery disease, measured as sensitivity, specificity, positive—(PPV) and negative predictive value (NPV). Seven studies were included, with a cumulative sample size of 1,275 patients. The patient-based pooled sensitivity, specificity, PPV and NPV were 95, 65, 71 and 94% respectively. Quality assessment revealed excellent and good quality in terms of applicability and risk of bias respectively, with the main concern being patient selection. In conclusion, on the basis of a significance cut-off value of 50% diameter stenosis, CTCA provides acceptable diagnostic accuracy for the exclusion of coronary artery disease in patients referred for TAVI. Using the routinely performed preoperative computed tomography scans as a gatekeeper for coronary angiography could decrease additional coronary angiographies by 37% in this high-risk and fragile population.
KW - Aortic stenosis
KW - Computed tomography coronary angiography
KW - Coronary angiography
KW - Coronary artery disease
KW - Diagnostic accuracy
KW - Transcatheter aortic valve implantation
UR - http://www.scopus.com/inward/record.url?scp=85058173342&partnerID=8YFLogxK
U2 - 10.1007/s12471-018-1149-6
DO - 10.1007/s12471-018-1149-6
M3 - Review article
AN - SCOPUS:85058173342
SN - 1568-5888
VL - 26
SP - 591
EP - 599
JO - Netherlands Heart Journal
JF - Netherlands Heart Journal
IS - 12
ER -