title: Accuracy of Computed Tomographic Angiography and Single-Photon Emission Computed Tomography-Acquired Myocardial Perfusion Imaging for the Diagnosis of Coronary Artery Disease.
abstract: BACKGROUND
  Establishing the diagnosis of coronary artery disease (CAD) in symptomatic patients allows appropriately allocating preventative measures. Single-photon emission computed tomography (CT)-acquired myocardial perfusion imaging (SPECT-MPI) is frequently used for the evaluation of CAD, but coronary CT angiography (CTA) has emerged as a valid alternative.
  
  
  RESULTS
  We compared the accuracy of SPECT-MPI and CTA for the diagnosis of CAD in 391 symptomatic patients who were prospectively enrolled in a multicenter study after clinical referral for cardiac catheterization. The area under the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of CTA and SPECT-MPI for identifying patients with CAD defined as the presence of ≥1 coronary artery with ≥50% lumen stenosis by quantitative coronary angiography. Sensitivity to identify patients with CAD was greater for CTA than SPECT-MPI (0.92 versus 0.62, respectively; P<0.001), resulting in greater overall accuracy (area under the receiver operating characteristic curve, 0.91 [95% confidence interval, 0.88-0.94] versus 0.69 [0.64-0.74]; P<0.001). Results were similar in patients without previous history of CAD (area under the receiver operating characteristic curve, 0.92 [0.89-0.96] versus 0.67 [0.61-0.73]; P<0.001) and also for the secondary end points of ≥70% stenosis and multivessel disease, as well as subgroups, except for patients with a calcium score of ≥400 and those with high-risk anatomy in whom the overall accuracy was similar because CTA's superior sensitivity was offset by lower specificity in these settings. Radiation doses were 3.9 mSv for CTA and 9.8 for SPECT-MPI (P<0.001).
  
  
  CONCLUSIONS
  CTA is more accurate than SPECT-MPI for the diagnosis of CAD as defined by conventional angiography and may be underused for this purpose in symptomatic patients.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00934037.
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Armin
authors.initials: A
authors.lastname: Arbab-Zadeh
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.). mdicarli@partners.org.
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Cerci
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Richard T
authors.initials: RT
authors.lastname: George
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Marcus Y
authors.initials: MY
authors.lastname: Chen
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Marc
authors.initials: M
authors.lastname: Dewey
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Niinuma
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Vavere
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Aisha
authors.initials: A
authors.lastname: Betoko
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Michail
authors.initials: M
authors.lastname: Plotkin
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Clouse
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Arai
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Brinker
authors.affiliation: From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
authors.forename: Julie M
authors.initials: JM
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
keywords: ROC curve; coronary angiography; coronary artery disease; myocardial ischemia; myocardial perfusion imaging