TOPLINE:

CT coronary angiography (CTCA) was found to be safe and effective for evaluating coronary artery disease in patients with a low-to-intermediate pretest probability of the disease. It demonstrated a high negative predictive value and good sensitivity and specificity and led to a significant reduction in the diagnosis time compared with invasive CA.

METHODOLOGY:

• Researchers conducted a single-centre non-randomised trial involving 100 patients (67% men) with a low-to-intermediate pretest probability of coronary artery disease in Germany between November 2019 and April 2022.
• Patients were randomly assigned in a 1:2 ratio to undergo either CTCA (n = 30; mean age, 63 years) or invasive CA (n = 70; mean age, 65 years). Both groups underwent follow-up stress echocardiography after a minimum interval of 6 months.
• Across both groups, patients demonstrated similar distributions of cardiac risk factors, including hypertension, which was most prevalent; diabetes; and smoking.
• The primary outcome was the change in the Wall Motion Score Index (WMSI) from stress testing to resting conditions, with a threshold score > 0.37 indicating a significant risk for cardiac mortality during long-term follow-up.
• Secondary outcomes included mortality, myocardial infarction, hospital admissions for angina, and myocardial revascularisation procedures.

TAKEAWAY:

• Among 63 patients who completed follow-up (median time, 10 months), none of them in the CTCA or invasive CA group showed a change in the WMSI score > 0.37.
• At the follow-up, one patient in the invasive CA group died, and one patient in the CTCA group experienced angina; no instances of myocardial infarction or revascularisation were recorded in any of the groups.
• Diagnostic performance metrics of CTCA showed a sensitivity of 75% and a specificity of 77.27%, with a high negative predictive value of 89% for ruling out coronary artery disease.
• Compared with invasive CA, CTCA significantly reduced the diagnostic time (20.2 vs 4.7 hours; P < .0001); however, it had a higher mean radiation dose (1.5 vs 2.3 mSv; P = .03).

IN PRACTICE:

"Our study supports the assertion that CT coronary angiography (CTCA) is a safe and reliable non-invasive modality for the diagnosis or exclusion of coronary artery disease (CAD) when appropriate clinical indications are met," the authors wrote, suggesting a promising future of non-invasive diagnostics for CTCA, "especially with the emergence of photon-counting CTCA technology, enabling a substantially higher image resolution."

SOURCE:

This study was led by Migena Disha, Department of General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Ruhr University Bochum, Bochum, Germany. It was published online on September 03, 2025, in the Journal of Clinical Medicine.

LIMITATIONS:

The small sample size limited the study's ability to identify significant differences between the two groups. The COVID-19 pandemic resulted in 37 patients being lost to follow-up. Additionally, the non-randomised design may have introduced selection bias, and patient self-selection created additional bias.

DISCLOSURES:

This study did not receive any external funding, and the authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.