Diagnostic Performance of Coronary CT Angiography in Routine Clinical Practice: Comparison with Invasive Coronary Angiography in a Retrospective Cohort of 100 Patients

Abstract

Background: The rise of coronary CT angiography has substantially transformed the diagnostic assessment of coronary artery disease by offering a non-invasive alternative to coronary angiography. However, the accuracy and diagnostic performance of this technique remain closely linked to the characteristics of the study population and, in particular, to the extent of the calcified atherosclerotic burden. This underlines the value of assessing its performance in routine clinical practice. Aim: This study evaluated the diagnostic performance of coronary CT angiography in routine clinical practice. Methods: This retrospective, comparative and analytical study was conducted over a one-year period and involved 100 patients investigated for suspected coronary artery disease. All patients underwent coronary computed tomography angiography followed by invasive coronary angiography within a maximum of one month, allowing direct comparison between the two diagnostic modalities. The diagnostic performance of CT coronary angiography was evaluated using sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy, together with the Youden index and Cohen's kappa coefficient. In addition, the influence of coronary calcium burden on diagnostic performance was assessed according to calcium score categories. Results: This retrospective study included 100 patients who underwent a coroscanner followed by invasive coronary angiography. Coronary CT angiography showed a sensitivity of 85.3%, a specificity of 59.1%, a negative predictive value of 88.6% and an overall diagnostic accuracy of 68.0%. Agreement between the two techniques was low to moderate (kappa = 0.384). Analysis by calcium score group revealed a significant influence of coronary calcification on diagnostic performance (p = 0.022), highlighting the central role of atherosclerotic burden in the interpretation of results. Conclusions: Beyond the simple detection of coronary stenoses, coronary CT angiography is now an integral part of a comprehensive approach to the assessment of atherosclerotic disease. These results support its value as a reliable non-invasive tool for ruling out significant coronary artery disease, whilst emphasising that the coronary calcium score remains a major determinant of its performance and must be incorporated into diagnostic interpretation.