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Clinical Implications of Moderate Coronary Stenosis on Coronary Computed Tomography Angiography in Patients with Stable Angina.

 Choongki Kim  ;  Sung-Jin Hong  ;  Chul-Min Ahn  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Young-Guk Ko  ;  Byoung-Wook Choi  ;  Donghoon Choi  ;  Yangsoo Jang  ;  Myeong-Ki Hong 
 Yonsei Medical Journal, Vol.59(8) : 937-944, 2018 
Journal Title
 Yonsei Medical Journal 
Issue Date
Coronary artery disease ; computed tomography angiography ; coronary stenosis
PURPOSE: The present study investigated the diagnostic accuracy and clinical implications of moderate stenosis (50-69%, Coronary Artery Disease Reporting and Data System, grade 3) on coronary computed tomography angiography (CCTA), compared with invasive coronary angiography (ICA). MATERIALS AND METHODS: Two hundred and seventy-six patients who underwent ICA due to moderate stenosis alone on CCTA were selected from our prospective registry cohort. RESULTS: Diagnostic concordance between CCTA and ICA was found in only 50 (18%) patients. Among the 396 vessels and 508 segments with moderate stenosis, diagnostic concordance was found in 132 vessels (33%) and 127 segments (25%). Segments with calcified plaque had lower diagnostic concordance than those with mixed or non-calcified plaque (22% vs. 28% vs. 27%, respectively, p=0.001). While calcified plaque burden did not have an influence on severe stenosis (≥70%) on ICA, higher burden of non-calcified plaque was correlated with a greater incidence of ICA-based severe stenosis, which was more frequent in patients with ≥3 segments of non-calcified plaque (75%) than those without non-calcified plaque (22%, p<0.001). Typical angina and mixed or non-calcified plaque were correlated with a higher incidence of under-diagnosis, while the use of next-generation computed tomography scanners reduced the incidence of under-diagnosis. Increased body weight, left circumflex artery involvement, and calcified plaque were independent factors that increased the risk of over-diagnosis of CCTA. CONCLUSION: The diagnosis of moderate stenosis by CCTA may be limited in estimating the exact degree of ICA-based anatomical stenosis. Unlike calcific burden, non-calcific burden was positively correlated with the presence of severe stenosis on ICA.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
고영국(Ko, Young Guk)
김병극(Kim, Byeong Keuk) ORCID logo https://orcid.org/0000-0003-2493-066X
김중선(Kim, Jung Sun) ORCID logo https://orcid.org/0000-0003-2263-3274
김충기(Kim, Choong Ki)
안철민(Ahn, Chul-Min) ORCID logo https://orcid.org/0000-0002-7071-4370
장양수(Jang, Yang Soo) ORCID logo https://orcid.org/0000-0002-2169-3112
최동훈(Choi, Dong Hoon) ORCID logo https://orcid.org/0000-0002-2009-9760
최병욱(Choi, Byoung Wook) ORCID logo https://orcid.org/0000-0002-8873-5444
홍명기(Hong, Myeong Ki) ORCID logo https://orcid.org/0000-0002-2090-2031
홍성진(Hong, Sung Jin) ORCID logo https://orcid.org/0000-0003-4893-039X
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