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. 2023 Aug 28;16(16):1990-2000.
doi: 10.1016/j.jcin.2023.05.030.

Effectiveness of Pre-TAVR CTA as a Screening Tool for Significant CAD Before TAVR

Nicholas P Kondoleon  1 , Habib Layoun  2 , Nikolaos Spilias  2 , Joseph Sipko  3 , Christopher Kanaan  3 , Serge Harb  2 , Grant Reed  2 , Rishi Puri  2 , James Yun  2 , Amar Krishnaswamy  2 , Samir R Kapadia  4
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Free article

Effectiveness of Pre-TAVR CTA as a Screening Tool for Significant CAD Before TAVR

Nicholas P Kondoleon et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Computed tomography angiography (CTA) and invasive coronary angiography (ICA) are routinely performed before transcatheter aortic valve replacement (TAVR) to assess aortic root anatomy and screen for coronary artery disease (CAD), respectively.

Objectives: This study explored the efficacy of CTA as a screening tool for significant proximal CAD before TAVR.

Methods: With proper ethical oversight, patients undergoing TAVR at Cleveland Clinic with a preprocedural CTA and invasive coronary angiography (ICA), and no prior percutaneous intervention, were identified from 2015 to 2021. Blinded to ICA results, the authors reviewed the left main, proximal left anterior descending coronary artery, proximal left circumflex coronary artery, and proximal right coronary artery by CTA coronary reconstruction to assess for nonsignificant stenosis (0% to 49%), moderate stenosis (50% to 69%), and severe stenosis (≥70%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen Kappa statistic were analyzed.

Results: 2,217 patients (53.4% male, age 79.2 ± 8.5 years) met inclusion criteria. CTA evaluation revealed a sensitivity of 90%, specificity of 92%, PPV of 74%, and NPV of 97% for detecting ≥50% stenosis. Using a ≥70% stenosis cutoff, evaluation revealed a sensitivity of 91%, specificity of 97%, PPV of 83%, and NPV of 99%. Assessment of bypass graft patency revealed a sensitivity of 86%, specificity of 97%, PPV of 84%, and NPV of 98%. Cohen Kappa analysis indicated substantial to near perfect agreement between pre-TAVR CTA and ICA.

Conclusions: Pre-TAVR CTA has a high NPV for high-grade proximal stenosis of each coronary artery. As a result, CTA can be used as a screening tool to rule out significant proximal CAD in patients undergoing TAVR.

Keywords: aortic stenosis; computed tomography angiography; coronary artery disease; invasive coronary angiography; transcatheter aortic valve replacement.

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Conflict of interest statement

Funding Support and Author Disclosures This study was supported by the Department of Cardiovascular Medicine and the Heart, Vascular, and Thoracic Institute at Cleveland Clinic. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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