title: Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data on the impact of calcium score.
abstract: OBJECTIVE
  This study evaluated the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) at different coronary calcium score (CACS) values with conventional coronary angiography (CAG) as the reference standard.
  
  
  METHODS
  A total of 1,500 patients (928 men, mean age 58.2±12.5 years) in sinus rhythm who underwent CTCA (64-slice technology) and CAG were enrolled. Diagnostic accuracy and likelihood ratios (LR) of CTCA were evaluated against CAG for the total population and in different CACS classes (0; 1-10; 11-100; 101-400; 401-1,000; >1,000).
  
  
  RESULTS
  The prevalence of obstructive disease was 51% (23.5% single vessel; 27.5% multivessel; progressive increase from 17.9% to 94% through the CACS classes). In the per-patient analysis, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CTCA were 99%, 92%, 94% and 99%, respectively. Per-patient analysis showed a worse PPV of CTCA (76-77%) in classes with low CACS (1-10/11-100). Per-patient LR were higher in classes with extreme CACS values (0 = LR+ 18.3 and LR- = 0.0; c1,000 = LR+ 17.0 and LR- = 0.0) with values always >7 for LR+ and <0.033 for LR- for all CACS classes.
  
  
  CONCLUSIONS
  CTCA is a reliable diagnostic modality, with high sensitivity and NPV regardless of CACS.
authors: Dipartimento di Radiologia e del Cardio-Polmonare, Azienda Ospedaliero-Universitaria di Parma, c/o Piastra Tecnica - Piano 0, Via Gramsci 14, 43100 Parma, Italy.
authors: E
authors: E
authors: Maffei
authors: C
authors: C
authors: Martini
authors: C
authors: C
authors: Tedeschi
authors: P
authors: P
authors: Spagnolo
authors: A
authors: A
authors: Zuccarelli
authors: T
authors: T
authors: Arcadi
authors: A
authors: A
authors: Guaricci
authors: S
authors: S
authors: Seitun
authors: A
authors: A
authors: Weustink
authors: N
authors: N
authors: Mollet
authors: F
authors: F
authors: Cademartiri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002114:Calcinosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed