title: Diagnostic accuracy of computed tomography coronary angiography according to pre-test probability of coronary artery disease and severity of coronary arterial calcification. The CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) International Multicenter Study.
abstract: OBJECTIVE
  The purpose of this study was to assess the impact of patient population characteristics on accuracy by computed tomography angiography (CTA) to detect obstructive coronary artery disease (CAD).
  
  
  BACKGROUND
  The ability of CTA to exclude obstructive CAD in patients of different pre-test probabilities and in presence of coronary calcification remains uncertain.
  
  
  METHODS
  For the CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) study, 371 patients underwent CTA and cardiac catheterization for the detection of obstructive CAD, defined as ≥50% luminal stenosis by quantitative coronary angiography (QCA). This analysis includes 80 initially excluded patients with a calcium score ≥600. Area under the receiver-operating characteristic curve (AUC) was used to evaluate CTA diagnostic accuracy compared to QCA in patients according to calcium score and pre-test probability of CAD.
  
  
  RESULTS
  Analysis of patient-based quantitative CTA accuracy revealed an AUC of 0.93 (95% confidence interval [CI]: 0.90 to 0.95). The AUC remained 0.93 (95% CI: 0.90 to 0.96) after excluding patients with known CAD but decreased to 0.81 (95% CI: 0.71 to 0.89) in patients with calcium score ≥600 (p = 0.077). While AUCs were similar (0.93, 0.92, and 0.93, respectively) for patients with intermediate, high pre-test probability for CAD, and known CAD, negative predictive values were different: 0.90, 0.83, and 0.50, respectively. Negative predictive values decreased from 0.93 to 0.75 for patients with calcium score <100 or ≥100, respectively (p = 0.053).
  
  
  CONCLUSIONS
  Both pre-test probability for CAD and coronary calcium scoring should be considered before using CTA for excluding obstructive CAD. For that purpose, CTA is less effective in patients with calcium score ≥600 and in patients with a high pre-test probability for obstructive CAD.
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, MD 21287, USA.
authors.forename: Armin
authors.initials: A
authors.lastname: Arbab-Zadeh
authors.forename: Julie M
authors.initials: JM
authors.lastname: Miller
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.forename: Marc
authors.initials: M
authors.lastname: Dewey
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Niinuma
authors.forename: Ilan
authors.initials: I
authors.lastname: Gottlieb
authors.forename: Narinder
authors.initials: N
authors.lastname: Paul
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Clouse
authors.forename: Edward P
authors.initials: EP
authors.lastname: Shapiro
authors.forename: John
authors.initials: J
authors.lastname: Hoe
authors.forename: Albert C
authors.initials: AC
authors.lastname: Lardo
authors.forename: David E
authors.initials: DE
authors.lastname: Bush
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Brinker
authors.forename: Joăo A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D061205:Vascular Calcification / Q000000981:diagnostic imaging*