Diagnostic performance of coronary angiography by 64-row CT.
BACKGROUND
The accuracy of multidetector computed tomographic (CT) angiography involving 64 detectors has not been well established.


METHODS
We conducted a multicenter study to examine the accuracy of 64-row, 0.5-mm multidetector CT angiography as compared with conventional coronary angiography in patients with suspected coronary artery disease. Nine centers enrolled patients who underwent calcium scoring and multidetector CT angiography before conventional coronary angiography. In 291 patients with calcium scores of 600 or less, segments 1.5 mm or more in diameter were analyzed by means of CT and conventional angiography at independent core laboratories. Stenoses of 50% or more were considered obstructive. The area under the receiver-operating-characteristic curve (AUC) was used to evaluate diagnostic accuracy relative to that of conventional angiography and subsequent revascularization status, whereas disease severity was assessed with the use of the modified Duke Coronary Artery Disease Index.


RESULTS
A total of 56% of patients had obstructive coronary artery disease. The patient-based diagnostic accuracy of quantitative CT angiography for detecting or ruling out stenoses of 50% or more according to conventional angiography revealed an AUC of 0.93 (95% confidence interval [CI], 0.90 to 0.96), with a sensitivity of 85% (95% CI, 79 to 90), a specificity of 90% (95% CI, 83 to 94), a positive predictive value of 91% (95% CI, 86 to 95), and a negative predictive value of 83% (95% CI, 75 to 89). CT angiography was similar to conventional angiography in its ability to identify patients who subsequently underwent revascularization: the AUC was 0.84 (95% CI, 0.79 to 0.88) for multidetector CT angiography and 0.82 (95% CI, 0.77 to 0.86) for conventional angiography. A per-vessel analysis of 866 vessels yielded an AUC of 0.91 (95% CI, 0.88 to 0.93). Disease severity ascertained by CT and conventional angiography was well correlated (r=0.81; 95% CI, 0.76 to 0.84). Two patients had important reactions to contrast medium after CT angiography.


CONCLUSIONS
Multidetector CT angiography accurately identifies the presence and severity of obstructive coronary artery disease and subsequent revascularization in symptomatic patients. The negative and positive predictive values indicate that multidetector CT angiography cannot replace conventional coronary angiography at present. (ClinicalTrials.gov number, NCT00738218.)
Miller
Julie M
JM
Johns Hopkins University School of Medicine, Baltimore 21287, USA.
Rochitte
Carlos E
CE
Dewey
Marc
M
Arbab-Zadeh
Armin
A
Niinuma
Hiroyuki
H
Gottlieb
Ilan
I
Paul
Narinder
N
Clouse
Melvin E
ME
Shapiro
Edward P
EP
Hoe
John
J
Lardo
Albert C
AC
Bush
David E
DE
de Roos
Albert
A
Cox
Christopher
C
Brinker
Jeffery
J
Lima
João A C
JA
D000368:Aged; D000787:Angina Pectoris / Q000145:classification / Q000000981:diagnostic imaging; D019540:Area Under Curve; D017023:Coronary Angiography / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013673:Technology Assessment, Biomedical; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods