Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study.
OBJECTIVE
This study sought to determine the diagnostic accuracy of 64-slice computed tomographic coronary angiography (CTCA) to detect or rule out significant coronary artery disease (CAD).


BACKGROUND
CTCA is emerging as a noninvasive technique to detect coronary atherosclerosis.


METHODS
We conducted a prospective, multicenter, multivendor study involving 360 symptomatic patients with acute and stable anginal syndromes who were between 50 and 70 years of age and were referred for diagnostic conventional coronary angiography (CCA) from September 2004 through June 2006. All patients underwent a nonenhanced calcium scan and a CTCA, which was compared with CCA. No patients or segments were excluded because of impaired image quality attributable to either coronary motion or calcifications. Patient-, vessel-, and segment-based sensitivities and specificities were calculated to detect or rule out significant CAD, defined as >or=50% lumen diameter reduction.


RESULTS
The prevalence among patients of having at least 1 significant stenosis was 68%. In a patient-based analysis, the sensitivity for detecting patients with significant CAD was 99% (95% confidence interval [CI]: 98% to 100%), specificity was 64% (95% CI: 55% to 73%), positive predictive value was 86% (95% CI: 82% to 90%), and negative predictive value was 97% (95% CI: 94% to 100%). In a segment-based analysis, the sensitivity was 88% (95% CI: 85% to 91%), specificity was 90% (95% CI: 89% to 92%), positive predictive value was 47% (95% CI: 44% to 51%), and negative predictive value was 99% (95% CI: 98% to 99%).


CONCLUSIONS
Among patients in whom a decision had already been made to obtain CCA, 64-slice CTCA was reliable for ruling out significant CAD in patients with stable and unstable anginal syndromes. A positive 64-slice CTCA scan often overestimates the severity of atherosclerotic obstructions and requires further testing to guide patient management.
Meijboom
W Bob
WB
Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Meijs
Matthijs F L
MF
Schuijf
Joanne D
JD
Cramer
Maarten J
MJ
Mollet
Nico R
NR
van Mieghem
Carlos A G
CA
Nieman
Koen
K
van Werkhoven
Jacob M
JM
Pundziute
Gabija
G
Weustink
Annick C
AC
de Vos
Alexander M
AM
Pugliese
Francesca
F
Rensing
Benno
B
Jukema
J Wouter
JW
Bax
Jeroen J
JJ
Prokop
Mathias
M
Doevendans
Pieter A
PA
Hunink
Myriam G M
MG
Krestin
Gabriel P
GP
de Feyter
Pim J
PJ
D000368:Aged; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed