Valvular & structural heart disease
Effectiveness of Pre-TAVR Computed Tomography Angiography (CTA) as a Screening Tool for Significant Coronary Artery Disease (CAD) Before Transcatheter Aortic Valve Replacement (TAVR)
Authors' conclusion
Pre-TAVR CTA has a high NPV for high-grade proximal stenosis of each coronary artery.
Study context
- Population
- Patients undergoing TAVR at Cleveland Clinic with preprocedural CTA and invasive coronary angiography (ICA) and no prior PCI, 2015–2021
- Participants
- 2,217 patients
- Comparison
- Pre-TAVR CTA vs ICA
- Outcome
- Diagnostic performance of CTA for significant proximal CAD (sensitivity, specificity, PPV, NPV, Cohen Kappa)
Methodological detailsretrospective, single-centre, blinded to ICA results
- Retrospective
- Single-centre
- Blinded to ICA results
Performance
As reported in the abstract
Detection of proximal coronary stenosis by CTA vs ICA
| Test or model | Sensitivity (≥50% stenosis) | Specificity (≥50% stenosis) | PPV (≥50% stenosis) | NPV (≥50% stenosis) | Sensitivity (≥70% stenosis) | Specificity (≥70% stenosis) | PPV (≥70% stenosis) | NPV (≥70% stenosis) |
|---|---|---|---|---|---|---|---|---|
| CTA | 90% | 92% | 74% | 97% | 91% | 97% | 83% | 99% |
CTA
Sensitivity (≥50% stenosis)90%
Specificity (≥50% stenosis)92%
PPV (≥50% stenosis)74%
NPV (≥50% stenosis)97%
Sensitivity (≥70% stenosis)91%
Specificity (≥70% stenosis)97%
PPV (≥70% stenosis)83%
NPV (≥70% stenosis)99%
Further findings
Bypass graft patency
- Sensitivity
- 86%
- Specificity
- 97%
- PPV
- 84%
- NPV
- 98%
Agreement between pre-TAVR CTA and ICA (Cohen Kappa)
- Substantial to near perfect agreement
Original publication
Effectiveness of Pre-TAVR CTA as a Screening Tool for Significant CAD Before TAVR. JACC Cardiovasc Interv. Published 28 August 2023. doi:10.
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