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03-09-2018 | Review Article | Uitgave 12/2018 Open Access

Netherlands Heart Journal 12/2018

CTCA for detection of significant coronary artery disease in routine TAVI work-up

A systematic review and meta-analysis

Tijdschrift:
Netherlands Heart Journal > Uitgave 12/2018
Auteurs:
T. P. W. van den Boogert, J. Vendrik, B. E. P. M. Claessen, J. Baan, M. A. Beijk, J. Limpens, S. A. M. Boekholdt, R. Hoek, R. N. Planken, J. P. Henriques
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12471-018-1149-6) contains supplementary material, which is available to authorized users.
All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Abstract

Transcatheter aortic valve implantation (TAVI) has evolved to standard treatment of severe aortic stenosis in patients with an intermediate to high surgical risk. Computed tomography coronary angiography (CTCA) could partially replace invasive coronary angiography to diagnose significant coronary artery disease in the work-up for TAVI. A literature search was performed in MEDLINE and EMBASE for papers comparing CTCA and coronary angiography in TAVI candidates. The primary endpoint was the diagnostic accuracy of CTCA, compared to coronary angiography, for detection of significant (>50% diameter stenosis) coronary artery disease, measured as sensitivity, specificity, positive—(PPV) and negative predictive value (NPV). Seven studies were included, with a cumulative sample size of 1,275 patients. The patient-based pooled sensitivity, specificity, PPV and NPV were 95, 65, 71 and 94% respectively. Quality assessment revealed excellent and good quality in terms of applicability and risk of bias respectively, with the main concern being patient selection. In conclusion, on the basis of a significance cut-off value of 50% diameter stenosis, CTCA provides acceptable diagnostic accuracy for the exclusion of coronary artery disease in patients referred for TAVI. Using the routinely performed preoperative computed tomography scans as a gatekeeper for coronary angiography could decrease additional coronary angiographies by 37% in this high-risk and fragile population.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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