Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data and review of multicentre trials.
OBJECTIVE
This study was undertaken to evaluate the diagnostic accuracy of computed tomography coronary angiography (CT-CA) for the detection of significant coronary artery stenosis (> or =50% lumen reduction) compared with conventional coronary angiography (CCA) in a registry and to review major multicentre trials.


METHODS
A total of 1,372 patients (882 men, 490 women; mean age 59.3+/-11.9 years) in sinus rhythm were studied with CT-CA (64-slice technology) and CCA. The diagnostic accuracy of CT-CA was evaluated against quantitative CCA as a reference standard for coronary artery stenosis. Positive and negative likelihood ratios and inter- and intraobserver agreement were calculated.


RESULTS
The prevalence of disease was 53%. CCA demonstrated the absence of significant coronary artery disease in 46.6% (639/1372), single-vessel disease in 24.7% (337/1372) and multivessel disease in 28.9% (396/1372) of patients. In per-patient analysis sensitivity, specificity and positive and negative predictive value of CT-CA were 99% [confidence interval (CI) 97-99], 92% (CI 89-94), 94% (CI 91-95) and 99% (CI 97-99), respectively. Per-patient and per-segment likelihood ratios (LR+=12.4 and LR-=0.011; LR+=18.3 and LR-=0.064, respectively), were good. Inter- and intraobserver variability was 0.78 and 0.85, respectively.


CONCLUSIONS
CT-CA is a reliable diagnostic modality both in terms of sensitivity and negative predictive value. Differences in trial results are also due to the different parameters used for patient inclusion.
Maffei
E
E
Dipartimento di Radiologia e del Cardio-Polmonare, Azienda Ospedaliero-Universitaria di Parma, c/o Piastra Tecnica, Piano 0, Via Gramsci 14, 43100, Parma, Italy.
Palumbo
A
A
Martini
C
C
Meijboom
W
W
Tedeschi
C
C
Spagnolo
P
P
Zuccarelli
A
A
Weustink
A
A
Torri
T
T
Mollet
N
N
Seitun
S
S
Krestin
G P
GP
Cademartiri
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011237:Predictive Value of Tests; D015995:Prevalence; D011857:Radiographic Image Interpretation, Computer-Assisted; D012042:Registries; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide