title: A review of adherence to the guidelines for coronary CT angiography quantitative stenosis grading thresholds in published research.
abstract: BACKGROUND
  The degree of coronary stenosis of potential hemodynamic significance is central to the interpretation of coronary computed tomography angiography (CCTA), but has been variably defined in the literature. Societal guidelines have attempted to address this issue via recommended thresholds.
  
  
  OBJECTIVE
  We surveyed the various thresholds for defining significant coronary stenosis reported in research published since the introduction of the Society for Cardiovascular Computed Tomography guidelines regarding the interpretation and reporting of CCTA.
  
  
  METHODS
  We systematically reviewed the results of bibliographic searches of all original research articles on CCTA, focusing on studies reporting > 25 subjects, to assess the definitions of severity of coronary lesions as found on CCTA. To enable comparisons, we stratified the methods of reporting lesion severity into ≥ 50%, 50% to 69%, and "others" (including infrequent reporting methods).
  
  
  RESULTS
  Fifty-nine11 published studies were identified and met inclusion criteria. Eighteen studies reported the severity of coronary stenosis using a definition of 50% to 69% as moderate stenosis; 35 studies defined ≥ 50% coronary stenosis as "stenosis," "significant stenosis," or "obstructive lesion" without distinguishing a threshold for moderate versus severe stenosis. Six studies utilized other thresholds, such as 20% to 75%, 40% to 69%, 40% to 70%, 40% to 79%, and 50% to 75% to define moderate coronary stenosis.
  
  
  CONCLUSIONS
  Fifty-three of 59 studies were graded in accordance with the recommended threshold of ≥ 50% defining potentially significant stenosis, with 18 studies reporting precisely in accordance with the guidelines-recommended thresholds of ≥ 50% narrowing as defining moderate stenosis and ≥ 70% narrowing as defining severe stenosis. Six studies were reported using alternative thresholds for significant stenosis. However, a majority of research studies published since 2009 do not follow the societal guidelines for stenosis grading, since these studies do not clearly describe the degree of coronary stenosis.
authors.affiliation: Department of Medicine, University at Buffalo, State University of New York, School of Medicine , Buffalo, NY.
authors.forename: Andres E
authors.initials: AE
authors.lastname: Carmona-Rubio
authors.forename: Ashley Mingshin
authors.initials: AM
authors.lastname: Lee
authors.forename: Stefan
authors.initials: S
authors.lastname: Puchner
authors.forename: Brian
authors.initials: B
authors.lastname: Ghoshhajra
authors.forename: Umesh C
authors.initials: UC
authors.lastname: Sharma
mesh_terms: D000465:Algorithms; D017023:Coronary Angiography / Q000592:standards*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology; D019983:Guideline Adherence; D006801:Humans
keywords: Coronary artery disease; coronary artery stenosis; coronary computerized tomography angiography; noninvasive cardiac imaging