16-MDCT coronary angiography versus invasive coronary angiography in acute chest pain syndrome: a blinded prospective study.
OBJECTIVE
The purpose of our study was to prospectively evaluate the usefulness of CT coronary angiography versus invasive coronary angiography for the detection of clinically significant coronary artery disease in patients hospitalized for acute chest pain syndrome.


METHODS
Sixty-six consecutive patients (52 men and 14 women; average age, 57 +/- 11 [SD] years) who were hospitalized for acute chest pain syndrome underwent CT coronary angiography and invasive coronary angiography within an average time interval of 4 days. ECG-gated CT coronary angiography was performed with a 16-MDCT scanner (0.42-sec rotation time, 16 x 0.75 mm detector collimation). Beta-blockers were not administered routinely, and thus the average heart rate was 71 +/- 11 beats per minute. CT coronary angiographic images were evaluated concurrently by two radiologists, who were blinded to invasive coronary angiography results, for stenoses having a diameter of 50% or more, using a 15-segment classification, including all segments 2 mm or more in diameter. The consensus interpretation was compared with results of invasive coronary angiography.


RESULTS
CT coronary angiography was technically successful in 59 patients (89%). After exclusion of 20 (3.1%) of 649 coronary segments, which were classified as nonevaluable by CT coronary angiography, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT coronary angiography for identifying significant coronary artery disease in the remaining 629 coronary segments were 80% (68/85), 89% (482/544), 52% (68/130), 97% (482/499), and 87% (550/629), respectively. The overall accuracy for the main vessels (left main, left anterior descending, left circumflex, and right coronary arteries) was 93%, 88%, 86%, and 86%, respectively.


CONCLUSIONS
CT coronary angiography using a 16-MDCT scanner enables accurate noninvasive detection of significant coronary artery disease in patients hospitalized for acute chest pain syndrome. Furthermore, relative high sensitivity and specificity of CT coronary angiography can be achieved without pharmacologic manipulation of patient heart rates.
Ghersin
Eduard
E
Department of Diagnostic Imaging, Rambam Medical Center, Haifa, Israel. e_ghersin@rambam.health.gov.il
Litmanovich
Diana
D
Dragu
Robert
R
Rispler
Shmuel
S
Lessick
Jonathan
J
Ofer
Amos
A
Brook
Olga R
OR
Gruberg
Luis
L
Beyar
Rafael
R
Engel
Ahuva
A
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D002637:Chest Pain / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide