CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression

D. Andreini, S. Mushtaq, G. Pontone, E. Conte, C. Collet, J. Sonck, A. D'Errico, L. Di Odoardo, M. Guglielmo, A. Baggiano, D. Trabattoni, P. Ravagnani, P. Montorsi, G. Teruzzi, P. Olivares, F. Fabbiocchi, S. De Martini, G. Calligaris, A. Annoni, M.E. ManciniA. Formenti, M. Magatelli, E. Consiglio, G. Muscogiuri, F. Lombardi, C. Fiorentini, A.L. Bartorelli, M. Pepi

Research output: Contribution to journalArticlepeer-review


Objectives: The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard. Background: Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation. Methods: Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses. Results: In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv. Conclusions: In patients with coronary stents, CTP significantly improved the diagnostic rate and accuracy of coronary CTA alone compared with both ICA and invasive FFR as gold standard.

Original languageEnglish
Pages (from-to)732-742
Number of pages11
JournalJACC: Cardiovascular Imaging
Issue number3
Publication statusPublished - 2020


  • coronary CT angiography
  • coronary stents
  • invasive coronary angiography
  • static CT perfusion
  • adenosine
  • iodixanol
  • metoprolol
  • nitric acid derivative
  • aged
  • Article
  • computed tomographic angiography
  • computer assisted tomography
  • coronary angiography
  • coronary artery dilatation
  • coronary artery disease
  • coronary stenting
  • diagnostic accuracy
  • disease exacerbation
  • effective dose (radiation)
  • exercise electrocardiography
  • female
  • fractional flow reserve
  • heart muscle perfusion
  • heart stress
  • human
  • image quality
  • in-stent restenosis
  • major clinical study
  • male
  • priority journal
  • radiation exposure
  • sensitivity and specificity
  • sinus rhythm
  • thorax pain


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