Photon-counting detector CT reduces the rate of referrals to invasive coronary angiography as compared to CT with whole heart coverage energy-integrating detector

Abstract

BackgroundWe sought to compare the degree of maximal stenosis and the rate of invasive coronary angiography (ICA) recommendations in patients who underwent coronary CT angiography (CCTA) with photon-counting detector CT (PCD-CT) versus those who underwent CCTA with whole heart coverage energy-integrating detector CT (EID-CT). MethodsIn our retrospective single-center study, we included consecutive patients with suspected CAD who underwent CCTA performed with either PCD-CT or a 280-slice EID-CT. The degree of coronary stenosis was classified as no CAD, minimal (1–24 ​%), mild (25–49 ​%), moderate (50–69 ​%), severe stenosis (70–99 ​%), or occlusion. ResultsA total of 812 consecutive patients were included in the analysis, 401 patients scanned with EID-CT and 411 patients with PCD-CT (mean age: 58.4 ​± ​12.4 years, 45.4 ​% female). Despite the higher total coronary artery calcium score (CACS) in the PCD-CT group (10 [interquartile range (IQR) ​= ​0–152.8] vs 1 [IQR ​= ​0–94], p ​< ​0.001), obstructive CAD was more frequently reported in the EID-CT vs PCD-CT group (no CAD: 28.7 ​% vs 26.0 ​%, minimal: 23.2 ​% vs 30.9 ​%, mild: 19.7 ​% vs 23.4 ​%, moderate: 14.5 ​% vs 9.7 ​%, severe: 11.5 ​% vs 8.5 ​% and occlusion: 2.5 ​% vs 1.5 ​%, respectively, p ​= ​0.025). EID-CT was independently associated with downstream ICA (OR ​= ​2.76 [95%CI ​= ​1.58–4.97] p ​< ​0.001) in the overall patient population, in patients with CACS<400 (OR ​= ​2.18 [95%CI ​= ​1.13–4.39] p ​= ​0.024) and in patients with CACS≥400 (OR ​= ​3.83 [95%CI ​= ​1.42–11.05] p ​= ​0.010). ConclusionIn patients who underwent CCTA with PCD-CT the number of subsequent ICAs was lower as compared to patients who were scanned with EID-CT. This difference was greater in patients with extensive coronary calcification.