title: Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data in NSTEMI acute coronary syndrome and influence of gender and risk factors.
abstract: OBJECTIVE
  This study sought to evaluate the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) compared with conventional coronary angiography (CAG) in non-ST-elevation myocardial infarction-acute coronary syndrome (NSTEMI-ACS) and in subgroups selected by gender and number of risk factors (RF).
  
  
  METHODS
  We selected from a population of 1,500 patients in a multicentre registry with NSTEMI-ACS who had undergone CTCA and CAG, (n=237; 187 men, mean age 63±10 years). Diagnostic accuracy and likelihood ratios (LR) of CTCA were assessed against CAG in the total population and subgroups (men, women: 0 RF = absence of RF, 1-2 RF = presence of one or two RF, >2 RF = presence of more than two RF).
  
  
  RESULTS
  The prevalence of obstructive disease was 53%. In the per-patient analysis, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CTCA were 100% (men 100%; women 100%; 0 RF 100%; 1-2 RF 100%; >2 RF 100%), 95% (men 98%; women 50%; 0 RF NA% (NA, not assessable); 1-2 RF 96%; >2 RF 96%), 95% (men 98%; women 91%; 0 RF 91%; 1-2 RF 96%; >2 RF 96%), 100% (men 100%; women 100%; 0 RF NV%; 1-2 RF 100%; >2 RF 100%), respectively. The per-segment analysis showed a reduction in PPV (ranging between 56% and 67%). The per-patient LR+ ranged between 18 and 27, whereas LR-were always 0. We observed no significant differences in diagnostic accuracy between subgroups.
  
  
  CONCLUSIONS
  CTCA is a reliable diagnostic modality with high sensitivity and NPV in NSTEMI-ACS patients who are not candidates for early revascularisation, regardless of gender and number of risk factors.
authors.affiliation: 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.forename: E
authors.initials: E
authors.lastname: Maffei
authors.forename: C
authors.initials: C
authors.lastname: Martini
authors.forename: C
authors.initials: C
authors.lastname: Tedeschi
authors.forename: P
authors.initials: P
authors.lastname: Spagnolo
authors.forename: A
authors.initials: A
authors.lastname: Zuccarelli
authors.forename: T
authors.initials: T
authors.lastname: Arcadi
authors.forename: A
authors.initials: A
authors.lastname: Guaricci
authors.forename: S
authors.initials: S
authors.lastname: Seitun
authors.forename: A C
authors.initials: AC
authors.lastname: Weustink
authors.forename: N R
authors.initials: NR
authors.lastname: Mollet
authors.forename: F
authors.initials: F
authors.lastname: Cademartiri
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging; D000367:Age Factors; D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D009204:Myocardial Revascularization / Q000379:methods; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D012737:Sex Factors; D014057:Tomography, X-Ray Computed