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Jayawardena SV, Foo EHW, Savage SA, Patwardhan YP, Ralota KK, Layland J, Samuel R. Vessel-level patterns and predictors of discordance between computed tomography coronary angiography and invasive coronary angiography. World J Cardiol 2026; 18(11): 127371 [DOI: 10.4330/wjc.127371]
World J Cardiol. Nov 26, 2026; 18(11): 127371 Published online Nov 26, 2026. doi: 10.4330/wjc.127371
Vessel-level patterns and predictors of discordance between computed tomography coronary angiography and invasive coronary angiography
Sisijaya Vinura Jayawardena, Edwin Hsiang Win Foo, Simon Angus Savage, Yash Pradeep Patwardhan, Kristoffer Ken Ralota, Jamie Layland, Rohit Samuel
Sisijaya Vinura Jayawardena, Edwin Hsiang Win Foo, Simon Angus Savage, Yash Pradeep Patwardhan, Kristoffer Ken Ralota, Rohit Samuel, Department of Cardiology, Peninsula Health, Frankston 3199, Victoria, Australia
Jamie Layland, Department of Medicine, Peninsula Health, Monash University, Frankston 3199, Victoria, Australia
Author contributions: Jayawardena SV, Foo EHW and Savage SA contributed to manuscript drafting; Jayawardena SV, Foo EHW, Savage SA and Patwardhan YP performed data abstraction using the standardised Microsoft Access collection form; Jayawardena SV rechecked all collected records; and Patwardhan YP undertook additional review of inconsistent or discrepant cases during the revisions; Ralota KK contributed to statistical analysis; Layland J served as the senior supervising author, providing overall scientific supervision and critical revision of the manuscript; Samuel R contributed to study supervision, critical manuscript revision and final approval; all authors reviewed and approved the revised manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Institutional review board statement: The study was approved by the Peninsula University Hospital ethics committee as a retrospective low-risk clinical study. The requirement for individual written informed consent was waived because the project involved retrospective review of existing clinical and imaging data. All extracted data were de-identified before analysis and managed in accordance with institutional privacy and governance requirements.
Informed consent statement: This study does not require an informed consent form.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: All extracted data were de-identified before analysis and managed in accordance with institutional privacy and governance requirements.
Corresponding author: Sisijaya Vinura Jayawardena, MD, Department of Cardiology, Peninsula Health, 2 Hastings Road, Frankston 3199, Victoria, Australia. j.vinura@gmail.com
Received: August 28, 2026 Revised: October 9, 2026 Accepted: November 2, 2026 Published online: November 26, 2026 Processing time: 77 Days and 7.1 Hours
Core Tip
Core Tip: In this selected real-world cohort undergoing paired computed tomography coronary angiography (CTCA) and invasive coronary angiography (ICA), greater visual patient-level coronary calcium burden was associated with discordance at both patient and vessel levels, confirming a recognised limitation of CTCA in calcified disease. Discordance varied substantially by epicardial territory, with the left anterior descending artery showing the highest and left main coronary artery the lowest observed rates. These findings are consistent with treating a severe CTCA result as the beginning of a clinical decision process rather than as an automatic indication for ICA: The anatomical abnormality should be reconciled with symptoms and overall clinical context, with functional assessment considered where appropriate and ICA used when invasive clarification is clinically warranted. The territory-specific pattern and hierarchical analysis add descriptive information beyond the established calcium effect, but these findings are hypothesis-generating and require external validation with blinded reproducibility assessment, quantitative calcium measurement, and physiological or intravascular correlation.
