Computed tomographic angiography or conventional coronary angiography in therapeutic decision-making.
OBJECTIVE
To evaluate non-invasive angiography using dual-source computed tomography (CT) for the determination of the most appropriate therapeutic strategy in patients with suspected coronary artery disease (CAD).


RESULTS
CT angiography (Dual Source CT, Somatom Definition, Siemens Medical Systems, Forchheim, Germany) was performed in 60 consecutive patients [51 men, median age 64 (57-70) years] scheduled for elective coronary angiography. Both techniques were used to evaluate the presence of CAD, significant stenosis, and the need for revascularization therapy. Sensitivity and specificity for the presence of significant stenosis were: per segment (n = 766) 62% (95% CI 50-72) (64/104) and 79% (95% CI 74-84) (526/662), respectively; per patient (n = 60) 100% (95% CI 91-100) (38/38) and 45% (95% CI 24-68) (10/22), respectively. In therapeutic decision-making based on CT angiography, sensitivity, specificity, positive and negative predictive values for intervention were 97% (95% CI 84-100) (36/37), 48% (95% CI 27-69) (11/23), 75% (95% CI 60-86) (36/48), and 92% (95% CI 60-100) (11/12), respectively. If a revascularization procedure was needed, the CT angiographic data indicated the appropriate modality (percutaneous coronary intervention or coronary artery bypass grafting) in 70% (26/36) of patients.


CONCLUSIONS
Although imaging qualities have improved considerably, CT angiography cannot be used for definitive therapeutic decision-making with regard to revascularization procedures in patients with suspected CAD.
Department of Cardiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands. l.h.piers@thorax.umcg.nl
Lieuwe H
LH
Piers
Riksta
R
Dikkers
Tineke P
TP
Willems
Bart J G L
BJ
de Smet
Matthijs
M
Oudkerk
Felix
F
Zijlstra
René A
RA
Tio
D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy; D003657:Decision Making; D005260:Female; D005858:Germany; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*