ArticleEuropean journal of radiology open2026
Left main coronary artery stenosis assessment on coronary CT angiography.
Article in European journal of radiology open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Assessment of Left Main Coronary Artery (LMCA) stenosis is critical due to its prognostic significance. LMCA cross-sectional area in Coronary Computed Tomography Angiography (CCTA) can provide a non-invasive alternative, but data on its correlation with IVUS remain limited, particularly in different ethnic groups. This study aimed to evaluate CT LM-CSA in determining significant left main stenosis compared to IVUS-MLA in Iranian patients. Methods: We included patients who underwent IVUS for LM stenosis evaluation and had CCTA performed within a maximum of 90 days before IVUS. LM-CSA measured at the narrowest segment on CCTA and MLA obtained via IVUS. Correlation assessed using Pearson's coefficient; agreement evaluated with Bland-Altman analysis. Receiver operating characteristic (ROC) analysis determined the optimal LM-CSA cut-off. Results: Forty-five patients were included (mean age 59.2 ± 10.1 years; 60% male). IVUS-defined significant LMCA stenosis (MLA <6.0 mm²) was present in 33.3% patients. Baseline characteristics were similar between groups. CCTA-derived LM-CSA showed a strong correlation with IVUS-derived MLA (r = 0.93, p < 0.001). A CT-derived LM-CSA cut-off of 6.2 mm² identified for predicting significant stenosis, yielding 95.6% diagnostic accuracy and an AUC of 0.94 (95% CI: 0.86-1.00), with sensitivity of 88.2% (95% CI: 63.6-98.5%), specificity of 100% (95% CI: 87.7-100%), positive predictive value of 100% (95% CI: 78.2-100%), and negative predictive value of 93.3% (95% CI: 77.9-99.2%). Conclusions: CCTA LM-CSA is a reliable non-invasive metric for LMCA stenosis assessment. The optimized cut-off provides a threshold derived in an Iranian cohort that requires further validation before it can be used to guide deferral of invasive procedures.
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