title: Accuracy of multidetector computed tomography for detection of coronary artery stenosis in acute coronary syndrome compared with stable coronary disease: a CORE64 multicenter trial substudy.
abstract: BACKGROUND
  Multi-detector computed tomography angiography (MDCTA) is a promising method for risk assessment of patients with acute chest pain. However, its diagnostic performance in higher-risk patients has not been investigated in a large international multicenter trial. Therefore, in the present study we sought to estimate the diagnostic accuracy of MDCTA to detect significant coronary stenosis in patients with acute coronary syndrome (ACS).
  
  
  METHODS
  Patients included in the CORE64 study were categorized as suspected-ACS or non-ACS based on clinical data. A 64-row coronary MDCTA was performed before invasive coronary angiography (ICA) and both exams were evaluated by blinded, independent core laboratories.
  
  
  RESULTS
  From 371 patients included, 94 were categorized as suspected ACS and 277 as non-ACS. Patient-based analysis showed an area under the receiver-operating-characteristic curve (AUC) for detecting ≥ 50% coronary stenosis of 0.95 (95% CI: 0.88-0.98) in ACS and 0.92 (95% CI: 0.88-0.95) in non-ACS group (P=0.29). The sensitivity, specificity, positive and negative predictive values of MDCTA were 0.90(0.80-0.96), 0.88(0.70-0.98), 0.95(0.87-0.99) and 0.77(0.58-0.90) in suspected ACS patients and 0.87(0.81-0.92), 0.86(0.79-0.92), 0.91(0.85-0.95) and 0.82(0.74-0.89) in non-ACS patients (P NS for all comparisons). The mean calcium scores (CS) were 282 ± 449 in suspected ACS and 435 ± 668 in non-ACS group. The accuracy of CS to detect significant coronary stenosis was only moderate and the absence or minimal coronary artery calcification could not exclude the presence of significant coronary stenosis, particularly in ACS patients.
  
  
  CONCLUSIONS
  The diagnostic accuracy of MDCTA to detect significant coronary stenosis is high and comparable for both ACS and non-ACS patients.
authors.affiliation: Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Sara
authors.affiliation: Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: rochitte@incor.usp.br.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.affiliation: Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.affiliation: Iwate Medical University, Morioka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Niinuma
authors.affiliation: Charité Medical School, Humboldt-Universität zu Berlin and Freie Universität zu Berlin, Berlin.
authors.forename: Marc
authors.initials: M
authors.lastname: Dewey
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Shapiro
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Ilan
authors.initials: I
authors.lastname: Gottlieb
authors.affiliation: Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Antônio P
authors.initials: AP
authors.lastname: Mansur
authors.affiliation: Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: José C
authors.initials: JC
authors.lastname: Nicolau
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Lardo
authors.affiliation: D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.
authors.forename: Clerio F
authors.initials: CF
authors.lastname: Azevedo
authors.affiliation: Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil-Filho
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Vavere
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Silvia
authors.initials: S
authors.lastname: Cohn
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Brinker
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Miller
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, United States.
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000592:standards*; D011446:Prospective Studies
keywords: Acute coronary syndrome; Angiography; Multi-detector computed tomography angiography; Tomography