Non-invasive clinical assessment and stress testing parameters are only “weakly predictive” of left main coronary artery disease on computed tomography angiography (CTA) in patients with moderate or severe ischemia, a new analysis of trial data suggests.

The study, published online Monday and in the Feb. 22 issue of the Journal of the American College of Cardiology, presents data from a post hoc analysis of the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial, set up identify markers of left main disease (LMD) as detected on coronary CTA using clinical and stress testing parameters.

Led by Roxy Senior, MD, DM, from Northwick Park Hospital-Royal Brompton Hospital, London, the authors said the detection of significant (≥50%) LMD has major prognostic and therapeutic implications, noting that although the detection of obstructive coronary artery disease (CAD) is important, “this is especially true of LMD because current guidelines recommend revascularization to improve survival when LMD is present.”