title: Assessment of coronary artery stenosis by coronary angiography: a head-to-head comparison with pathological coronary artery anatomy.
abstract: BACKGROUND
  Conventional coronary angiography (CCA) has been considered as a gold standard for the diagnosis of coronary artery diseases; however, its diagnostic accuracy is still unknown.
  
  
  RESULTS
  Between July 2004 and December 2011, 97 patients underwent CCA within 15 days before heart transplantation in Fuwai hospital. A head-to-head comparison study was performed to examine the diagnostic accuracy of CCA as compared with that of pathological coronary artery anatomy. As confirmed by pathological coronary artery anatomy, 44 (45.4%) patients had coronary artery diseases. The patient-based diagnostic accuracy evaluation showed that the area under the receiver-operating characteristic curve of CCA for detecting ≥50% stenosis was 0.91, with a sensitivity of 91%, a specificity of 93%, and high concordance (κ=0.83). A per-vessel analysis of 291 vessels yielded an AUC of 0.79, the agreement of 3 vessels >0.6 (κ statistic). The area under the receiver-operating characteristic curve was 0.88 for proximal and middle segments, and was 0.62 for distal segments, κ was calculated to detect the distal segments with lower concordance than proximal and middle segments. The patient- and vessel-based evaluations showed similar diagnostic accuracy of CCA in detecting ≥75% stenosis. Per-segment evaluation found CCA was more accurate for detecting ≥50% and ≥75% stenosis in proximal and middle segments than in distal segments, and the diagnosis ability decreased in more severe stenosis segments and more complex lesions.
  
  
  CONCLUSIONS
  The accuracy of CCA is quite high in detecting coronary artery stenosis in patients- and vessels-based levels. However, the diagnosis ability decreased in more severe and complex lesions, especially for distal segments.
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Song
authors.initials: S
authors.lastname: Jiangping
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhe
authors.forename: Wang
authors.initials: W
authors.lastname: Wei
authors.forename: Song
authors.initials: S
authors.lastname: Yunhu
authors.forename: Huang
authors.initials: H
authors.lastname: Jie
authors.forename: Wang
authors.initials: W
authors.lastname: Hongyue
authors.forename: Zhao
authors.initials: Z
authors.lastname: Hong
authors.forename: Hu
authors.initials: H
authors.lastname: Shengshou
mesh_terms: D019540:Area Under Curve; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D007564:Japan; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index
keywords: coronary angiography; coronary artery; diagnosis; pathology