Diagnostic Accuracy of Coronary CT Angiography in Ruling Out Significant Coronary Artery Disease in Candidates for Transcatheter Aortic Valve Replacement.

Obstructive coronary artery disease (CAD) is common in patients undergoing transcatheter aortic valve implantation (TAVI). While invasive coronary angiography (ICA) is the gold standard for coronary evaluation, coronary computed tomography angiography (cCTA) is gaining interest for its potential to exclude obstructive CAD during pre-procedural imaging. This study aimed to assess the diagnostic accuracy of cCTA in ruling out significant CAD in TAVI candidates. We retrospectively analyzed 95 TAVI candidates (mean age 77.7 ± 8.5 years) who underwent both cCTA and ICA. Diagnostic performance of cCTA-sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy-was assessed using ICA as the reference, in both patient- and vessel-based models. Obstructive CAD was defined as ≥50% luminal stenosis or occlusion of a stent/bypass graft. ICA detected obstructive CAD in 27 patients (28.4%). Excluding non-evaluable cases, cCTA showed a negative predictive value (NPV) of 97% (patient-level) and 95% (vessel-level), with a diagnostic accuracy of 85% and 87%, respectively. Including all patients, regardless of scan quality, the NPV remained high (97%), although overall accuracy dropped to 67% (patient-level) and 66% (vessel-level). cCTA demonstrated high accuracy in excluding significant CAD, with a stable NPV of 95-97%. The relatively high rate of non-diagnostic scans and the single-center, retrospective design suggest that its role should be considered complementary to ICA, potentially reducing-but not replacing-the need for ICA in selected TAVI candidates.