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.