title: Diagnostic value of coronary CT angiography in comparison with invasive coronary angiography and intravascular ultrasound in patients with intermediate coronary artery stenosis: results from the prospective multicentre FIGURE-OUT (Functional Imaging criteria for GUiding REview of invasive coronary angiOgraphy, intravascular Ultrasound, and coronary computed Tomographic angiography) study.
abstract: OBJECTIVE
  The anatomical criteria for the diagnosis of ischaemia referenced by fractional flow reserve (FFR) from non-invasive coronary computed tomographic angiography (CCTA), invasive coronary angiography (ICA), and intravascular ultrasound (IVUS) have not been evaluated contemporarily in a large-scale study. The aim of this study was to assess the diagnostic value of CCTA compared with ICA and IVUS in patients with intermediate coronary stenosis.
  
  
  RESULTS
  CCTA, ICA, IVUS, and FFR were performed in 181 coronary lesions with intermediate severity. Minimal lumen diameter (MLD) and per cent diameter stenosis (%DS) were determined by CCTA and ICA, whereas minimal lumen area (MLA) was determined by CCTA and IVUS. Inducible ischaemia was defined by FFR ≤ 0.80. Diagnostic performances from non-invasive and invasive methods were compared. FFR ≤ 0.80 was observed in 49 (27.1%) lesions. CCTA MLD was smaller than ICA MLD (1.3 ± 0.5 vs. 1.5 ± 0.4 mm, P < 0.001), CCTA %DS was higher than ICA %DS (54.0 ± 14.0 vs. 50.3 ± 12.8%, P < 0.001), and CCTA MLA was smaller than IVUS MLA (2.2 ± 1.2 vs. 3.2 ± 1.2 mm(2), P < 0.001). This trend was consistent irrespective of lesion location, lesion severity, and plaque characteristics. For the determination of ischaemia, diagnostic performance of CCTA %DS was lower than ICA %DS [area under the curve (AUC) 0.657 vs. 0.765, P = 0.04], and that of CCTA MLA was lower than IVUS MLA (AUC 0.712 vs. 0.801, P = 0.03).
  
  
  CONCLUSIONS
  Anatomical criteria for the diagnosis of ischaemia-producing coronary stenosis differ by non-invasive and invasive methods. Compared with invasive methods, CCTA presents overestimation in assessing lesion severity and lower diagnostic performance in assessing ischaemia.
authors: Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors: Joon-Hyung
authors: JH
authors: Doh
authors: Department of Medicine, Seoul National University Hospital, Seoul, Korea bkkoo@snu.ac.kr bkk1214@gmail.com.
authors: Bon-Kwon
authors: BK
authors: Koo
authors: Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
authors: Chang-Wook
authors: CW
authors: Nam
authors: Department of Medicine, Dongguk University Ilsan Hospital, Dongguk University Graduate School, Goyang, Korea.
authors: Ji-Hyun
authors: JH
authors: Kim
authors: Department of Imaging and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors: James K
authors: JK
authors: Min
authors: Department of Imaging and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors: Ryo
authors: R
authors: Nakazato
authors: PGI Cikini Hospital, Jakarta, Indonesia.
authors: Todung
authors: T
authors: Silalahi
authors: PGI Cikini Hospital, Jakarta, Indonesia.
authors: Hardjo
authors: H
authors: Prawira
authors: Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors: Hyunmin
authors: H
authors: Choi
authors: Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors: Sung Yun
authors: SY
authors: Lee
authors: Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors: June
authors: J
authors: Namgung
authors: Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors: Sung Uk
authors: SU
authors: Kwon
authors: Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors: Jae-Jin
authors: JJ
authors: Kwak
authors: Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors: Won Ro
authors: WR
authors: Lee
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: coronary computed tomographic angiography; coronary disease; fractional flow reserve; intravascular ultrasound; myocardial ischaemia