title: Diagnostic performance of computed tomography coronary angiography (from the Prospective National Multicenter Multivendor EVASCAN Study).
abstract: Computed tomographic coronary angiography (CTCA) has been proposed as a noninvasive test for significant coronary artery disease (CAD), but only limited data are available from prospective multicenter trials. The goal of this study was to establish the diagnostic accuracy of CTCA compared to coronary angiography (CA) in a large population of symptomatic patients with clinical indications for coronary imaging. This national, multicenter study was designed to prospectively evaluate stable patients able to undergo CTCA followed by conventional CA. Data from CTCA and CA were analyzed in a blinded fashion at central core laboratories. The main outcome was the evaluation of patient-, vessel-, and segment-based diagnostic performance of CTCA to detect or rule out significant CAD (≥50% luminal diameter reduction). Of 757 patients enrolled, 746 (mean age 61 ± 12 years, 71% men) were analyzed. They underwent CTCA followed by CA 1.7 ± 0.8 days later using a 64-detector scanner. The prevalence of significant CAD in native coronary vessels by CA was 54%. The rate of nonassessable segments by CTCA was 6%. In a patient-based analysis, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of CTCA were 91%, 50%, 68%, 83%, 1.82, and 0.18, respectively. The strongest predictors of false-negative results on CTCA were high estimated pretest probability of CAD (odds ratio [OR] 1.97, p <0.001), male gender (OR 1.5, p <0.002), diabetes (OR 1.5, p <0.0001), and age (OR 1.2, p <0.0001). In conclusion, in this large multicenter study, CTCA identified significant CAD with high sensitivity. However, in routine clinical practice, each patient should be individually evaluated, and the pretest probability of obstructive CAD should be taken into account when deciding which method, CTCA or CA, to use to diagnose its presence and severity.
authors.affiliation: Department of Cardiology, Henri Mondor Hospital and University of Paris Est Créteil, Créteil, France. pascal.gueret@hmn.aphp.fr
authors.forename: Pascal
authors.initials: P
authors.lastname: Gueret
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Deux
authors.forename: Laurent
authors.initials: L
authors.lastname: Bonello
authors.forename: Anthony
authors.initials: A
authors.lastname: Sarran
authors.forename: Christophe
authors.initials: C
authors.lastname: Tron
authors.forename: Luc
authors.initials: L
authors.lastname: Christiaens
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Dacher
authors.forename: David
authors.initials: D
authors.lastname: Bertrand
authors.forename: Laurent
authors.initials: L
authors.lastname: Leborgne
authors.forename: Cedric
authors.initials: C
authors.lastname: Renard
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
authors.forename: Philippe
authors.initials: P
authors.lastname: Cluzel
authors.forename: Gerard
authors.initials: G
authors.lastname: Helft
authors.forename: Dominique
authors.initials: D
authors.lastname: Crochet
authors.forename: Hélène
authors.initials: H
authors.lastname: Vernhet-Kovacsik
authors.forename: Valérie
authors.initials: V
authors.lastname: Chabbert
authors.forename: Emile
authors.initials: E
authors.lastname: Ferrari
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.forename: Serge
authors.initials: S
authors.lastname: Willoteaux
authors.forename: Alain
authors.initials: A
authors.lastname: Furber
authors.forename: Gilles
authors.initials: G
authors.lastname: Barone-Rochette
authors.forename: Adrien
authors.initials: A
authors.lastname: Jankowski
authors.forename: Philippe
authors.initials: P
authors.lastname: Douek
authors.forename: Elie
authors.initials: E
authors.lastname: Mousseaux
authors.forename: Marc
authors.initials: M
authors.lastname: Sirol
authors.forename: Ralph
authors.initials: R
authors.lastname: Niarra
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Laissy
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*