Fig. 5

Proposed algorithm for the assessment for CAD in TAVI patients using CTA with CACS. Patients with a known diagnosis of CAD should be considered for ICA to clarify coronary anatomy. In patients with no known CAD and evaluable segments from CTA, the decision to pursue ICA will depend on the presence or absence of a 50% stenosis (left side of figure). In patients with no known CAD and evidence of non-evaluable segments on CTA, CACS thresholds can be incorporated into the decision making process. Decision towards further downstream testing using ICA can be considered in patients with CACS cut-off of 100 with high sensitivity and low specificity (or alternatively 400 with a lower sensitivity and higher specificity) respectively. CACS coronary artery calcium score, CAD coronary artery disease, ICA invasive coronary angiography