64-slice computed tomography coronary angiography: diagnostic accuracy in the real world.
OBJECTIVE
This study was done to evaluate the diagnostic accuracy of 64-slice computed tomography coronary angiography (CTCA) for the detection of significant coronary artery stenosis in the real clinical world.


METHODS
From the CTCA database of our institution, we enrolled 145 patients (92 men, 52 women, mean age 63.4 +/- 10.2 years) with suspected coronary artery disease. All patients presented with atypical or typical chest pain and underwent CTCA and conventional coronary angiography (CA). For the CTCA scan (Sensation 64, Siemens, Germany), we administered an IV bolus of 100 ml of iodinated contrast material (Iomeprol 400 mgI/ml, Bracco, Italy). The CTCA and CA reports used to evaluate diagnostic accuracy adopted > or =50% and > or =70%, respectively, as thresholds for significant stenosis.


RESULTS
Eleven patients were excluded from the analysis because of the nondiagnostic quality of CTCA. The prevalence of disease demonstrated at CA was 63% (84/134). Sensitivity, specificity and positive and negative predictive values for CTCA on a per-segment, per-vessel, and per-patient basis were 75.6%, 85.1%, 97.6%; 86.9%, 81.8%, 58.0%; 48.2%, 68.1%, 79.6%; and 95.7%, 92.3%, 93.5%, respectively. Only two out of 134 eligible patients were false negative. Heart rate did not significantly influence diagnostic accuracy, whereas the absence or minimal presence of coronary calcification improved diagnostic accuracy. The positive and negative likelihood ratios at the per-patient level were 2.32 and 0.041, respectively.


CONCLUSIONS
CTCA in the real clinical world shows a diagnostic performance lower than reported in previous validation studies. The excellent negative predictive value and negative likelihood ratio make CTCA a noninvasive gold standard for exclusion of significant coronary artery disease.
Cademartiri
F
F
Dipartimento di Radiologia e Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, Parma, Italy. filippocademartiri@hotmail.com
Maffei
E
E
Notarangelo
F
F
Ugo
F
F
Palumbo
A
A
Lina
D
D
Aldrovandi
A
A
Solinas
E
E
Reverberi
C
C
Menozzi
A
A
Vignali
L
L
Malagò
R
R
Midiri
M
M
Mollet
N R
NR
Cervellin
G
G
Ardissino
D
D
D000368:Aged; D003287:Contrast Media / Q000494:pharmacology; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D007558:Italy; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012107:Research Design; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol