title: Diagnostic accuracy of high-definition CT coronary angiography in high-risk patients.
abstract: OBJECTIVE
  To assess the diagnostic accuracy of computed tomography coronary angiography (CTCA) using a combination of high-definition CT (HD-CTCA) and high level of reader experience, with invasive coronary angiography (ICA) as the reference standard, in high-risk patients for the investigation of coronary artery disease (CAD).
  
  
  METHODS
  Three hundred high-risk patients underwent HD-CTCA and ICA. Independent experts evaluated the images for the presence of significant CAD, defined primarily as the presence of moderate (≥ 50%) stenosis and secondarily as the presence of severe (≥ 70%) stenosis in at least one coronary segment, in a blinded fashion. HD-CTCA was compared to ICA as the reference standard.
  
  
  RESULTS
  No patients were excluded. Two hundred and six patients (69%) had moderate and 178 (59%) had severe stenosis in at least one vessel at ICA. The sensitivity, specificity, positive predictive value, and negative predictive value were 97.1%, 97.9%, 99% and 93.9% for moderate stenosis, and 98.9%, 93.4%, 95.7% and 98.3%, for severe stenosis, on a per-patient basis.
  
  
  CONCLUSIONS
  The combination of HD-CTCA and experienced readers applied to a high-risk population, results in high diagnostic accuracy comparable to ICA. Modern generation CT systems in experienced hands might be considered for an expanded role.
authors.affiliation: Department of Radiology, Plymouth Hospital NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK. Electronic address: srikanthiye@gmail.com.
authors.forename: S S
authors.initials: SS
authors.lastname: Iyengar
authors.affiliation: Department of Cardiology, Plymouth Hospital NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
authors.forename: G
authors.initials: G
authors.lastname: Morgan-Hughes
authors.affiliation: Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), NIHR CLAHRC South West Peninsula, Veysey Building, Salmon Pool Lane, Exeter, Devon EX2 4SG, UK.
authors.forename: O
authors.initials: O
authors.lastname: Ukoumunne
authors.affiliation: Department of Cardiology, Plymouth Hospital NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
authors.forename: B
authors.initials: B
authors.lastname: Clayton
authors.affiliation: Department of Cardiology, Plymouth Hospital NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
authors.forename: E J
authors.initials: EJ
authors.lastname: Davies
authors.affiliation: Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), NIHR CLAHRC South West Peninsula, Veysey Building, Salmon Pool Lane, Exeter, Devon EX2 4SG, UK.
authors.forename: V
authors.initials: V
authors.lastname: Nikolaou
authors.affiliation: Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, Devon EX2 4SG, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Hyde
authors.affiliation: NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Royal Devon and Exeter Foundation NHS Trust, Barrack Road, Exeter, Devon EX2 5DW, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Shore
authors.affiliation: Department of Radiology, Plymouth Hospital NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK.
authors.forename: C A
authors.initials: CA
authors.lastname: Roobottom
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012306:Risk; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed