Diagnostic accuracy of computed tomography coronary angiography in a high risk symptomatic population.
OBJECTIVE
To evaluate the diagnostic accuracy of 64-slice computed tomography (CT) coronary angiography (CA) for the detection of significant coronary artery stenosis (> or = 50% lumen reduction) as compared to invasive coronary angiography (ICA) in a population of patients with chest pain and high risk.


METHODS
44 patients (30 male; mean age 60.2+/- 12.1 yrs) with chest pain were prospectively enrolled. In patients with heart rate > or = 70 bpm an oral dose of 100 mg of beta-blocker was administered. For CT-CA (Sensation 64, Siemens, Germany) an intravenous bolus of 100 ml of iodinated contrast material (Iomeron 400, Bracco, Italy) was injected. The average scan time was 13.3 +/- 0.9s. Two observers evaluated CT-CA vs. ICA as a reference standard for the detection of significant (> or = 50% lumen reduction) coronary artery stenosis.


RESULTS
ICA demonstrated the absence of coronary artery disease (CAD) in 13.6% of the patients (6/44), the presence of non significant CAD 4.6% (2/44), single vessel disease in 27.2% (12/44) and multi-vessel disease in 54.6% (24/44) of the patients. None of the patients was excluded from the study population. Ninety-three significant obstructive coronary lesions were observed. Sensitivity, specificity, positive and negative predictive value of CT-CA were 98.6% (70/71), 92.4% (97/105), 89.7% (70/78) and 99% (97/98), respectively. All patients with at least one significant coronary lesion were correctly identified by CT-CA.


CONCLUSIONS
CT-CA is a reliable alternative to ICA in a selected population of patients with chest pain and high risk.
Maffei
Erica
E
Department of Radiology and Cardiology, University Hospital of Parma,Parma, Italy.
Palumbo
Alessandro
A
Martini
Chiara
C
Ugo
Fabrizio
F
Lina
Daniela
D
Aldrovandi
Annachiara
A
Reverberi
Claudio
C
Manca
Carlo
C
Ardissino
Diego
D
Crisi
Girolamo
G
Cademartiri
Filippo
F
D000368:Aged; D015331:Cohort Studies; D003287:Contrast Media; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol