P2719The impact of “diseased only coronary artery” invasive diagnostics strategy on contrast and radiation dose in patients with coronary artery disease following coronary computed tomography angiography

• Published in: European heart journal 2019-10, Vol.40 (Supplement_1)
• Main Authors: Debski, M A, Kruk, M, Bujak, S, Dzielinska, Z, Demkow, M, Kepka, C
• Format: Article
• Language: English
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz748.1036

Abstract Background Coronary computed tomography angiography (CTA) has high diagnostic accuracy in ruling out significant stenosis of coronary arteries in patients with intermediate probability of coronary artery disease. Based on CTA result, some patients are scheduled for invasive coronary angiography (ICA). As no specyfic guidelines exist for such situations, during ICA contrast media is routinely injected into both coronary arteries, irrespectively of CTA result. Conceivably, patients scheduled for ICA with one vessel disease may benefit from invasive interrogation limited to the diseased vessel only, presumably resulting in less contrast, lower radiation dose and less complications related to catheterization. Purpose The aim of this study was to analyse the potential trade-off between the benefits and costs of a “diseased-vessel-only” (>50% DS in CTA) invasive diagnostic approach in patients undergoing ICA following coronary CTA, as compared to the traditional “total ICA” (including both arteries regardless of CTA result) approach. The potential benefits were defined as contrast and radiation doses reduction during ICA and the costs were defined as missing significant coronary stenosis. Methods In 85 patients who underwent CTA and subsequently ICA we precisely measured contrast volume and radiation dose used to visualise each vessel during ICA. Then we proposed excluding a vessel (either left or right coronary artery) without >50% diameter stenosis in CTA from ICA, and studied how it would affect ICA contrast and radiation values. DS in CTA and ICA were assessed quantitatively. Results CTA sensitivity, specificity, positive predictive value and negative predictive value in diagnosing >50%DS as assessed by ICA were 95.2%, 96.2%, 91.6% and 97.9%, respectively. Applying