Screening coronary artery disease with computed tomography angiogram should limit normal invasive coronary angiogram, regardless of pre-test probability

Abstract Backgound Performing functional testing (FT) or a computed tomography angiogram (CCTA) before invasive coronary angiogram (ICA) is recommended for coronary artery disease (CAD). We aimed to evaluate, in a real life setting, the rate of strictly normal invasive coronary angiogram (ICA) following a positive non-invasive test. Methods We included all patients who underwent an ICA with a prior positive FT or CCTA. Patients were categorized in 5 subgroups, according to pre-test probability (PTP) of having a coronary artery disease (CAD). Main results of ICA were defined as normal ICA, non-obstructive CAD (non-oCAD) and obstructive CAD (oCAD). Results For 4952 patients who underwent ICA following either a positive FT (3276, 66.2%) or CCTA (1676, 33.8%), the PTP was: (1) low [ 65%; n = 965, 19.5%]. ICA showed no CAD (819 patients, 16.5%), non-oCAD (1193 patients, 24.1%) or oCAD (2940 patients, 59.4%). Without considering the PTP values, CCTA compared to FT showed less frequently normal ICA (7% vs. 16.5%), and more frequently CAD (non-oCAD 27.9% vs. 22.2%; oCAD 65.1% vs. 56.4%)(all P  Conclusion CCTA is a better alternative than FT to limit unnecessary ICA regardless of PTP value, without missing abnormal ICA.