Valvular & structural heart disease
Feasibility of Computed Tomography as a Gatekeeper for Invasive Angiography Before TAVR: A Pragmatic Real-World Experience
Authors' conclusion
In comparison with routine ICA pre-TAVR, integration of TAVR-CTA in our program resulted in up to 53% of patients exempted from ICA, while maintaining patient safety. This approach could have important clinical implications to improve patient access, experience, value, and throughput.
Study context
- Population
- Patients who underwent TAVR evaluation with either TAVR-CTA or invasive coronary angiography (ICA) to determine coronary artery disease (CAD) between 2017 and 2022, excluding prior coronary artery bypass graftsmedian age, 81 years, 46% women
- Participants
- 1,165 patients
- Comparison
- TAVR-CTA versus ICA for CAD screening pre-transcatheter aortic valve replacement (pre-TAVR)
- TAVR-CTAn = 464
- ICAn = 701
- Outcome
- Symptom-driven revascularization
- Follow-up
- 1 year post-TAVR
Main finding
As reported in the abstract
P = 0.158
Further findings
Prevalence of CAD · similar
P = 0.2
Acute coronary syndrome · 1 year after TAVR
P = 0.846
Unplanned ICA · 1 year after TAVR
P = 0.767
- Per-patient diagnostic performance of TAVR-CTA for obstructive CAD
- 89% · sensitivity · specificity 75% · positive predictive value 69% · negative predictive value 91%
Disposition after TAVR-CTA
- Exempted from ICA (absence of proximal obstructive CAD)
- 53%
- Inconclusive TAVR-CTA interpretation
- 17%
- Desired ICA despite CAD exclusion by TAVR-CTA
- 15%
- Obstructive CAD requiring further ICA
- 14%
- Elevated coronary artery calcium score and presence of stents associated with need for ICA after TAVR-CTA
Original publication
Feasibility of Computed Tomography as a Gatekeeper for Invasive Angiography Before TAVR: A Pragmatic Real-World Experience. Circ Cardiovasc Interv. Published 21 May 2025. doi:10.
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