320-row CT coronary angiography predicts freedom from revascularisation and acts as a gatekeeper to defer invasive angiography in stable coronary artery disease: a fractional flow reserve-correlated study

Objectives To determine the accuracy of 320-row multidetector coronary computed tomography angiography (M320-CCTA) to detect functional stenoses using fractional flow reserve (FFR) as the reference standard and to predict revascularisation in stable coronary artery disease. Methods One hundred and fifteen patients (230 vessels) underwent M320-CCTA and FFR assessment and were followed for 18 months. Diameter stenosis on invasive angiography (ICA) and M320-CCTA were assessed by consensus by two observers and significant stenosis was defined as >= 50 %. FFR <= 0.8 indicated functionally significant stenoses. Results M320-CCTA had 94 % sensitivity and 94 % negative predictive value (NPV) for FFR <= 0.8. Overall accuracy was 70 %, specificity 54 % and positive predictive value 65 %. On receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) for CCTA to predict FFR <= 0.8 was 0.74 which was comparable with ICA. The absence of a significant stenosis on M320-CCTA was associated with a 6 % revascularisation rate. M320-CCTA predicted revascularisation with an AUC of 0.71 which was comparable with ICA. Conclusions M320-CCTA has excellent sensitivity and NPV for functional stenoses and therefore may act as an effective gatekeeper to defer ICA and revascularisation. Like ICA, M320-CCTA lacks specificity for functional stenoses and only has moderate accuracy to predict the need for revascularisation. Key Points Important information about the heart is provided by 320-row multidetector CT coronary angiography (M320-CCTA). M320-CCTA accurately detects and excludes functional stenoses determined by fractional flow reserve (FFR). Non-significant stenoses on M320-CCTA associated with fewer cardiac events and less revascularisation. M320-CCTA may act as a gatekeeper for invasive angiography and inappropriate revascularisation. Like ICA, M320-CCTA only has moderate accuracy to predict vessels requiring revascularisation.