title: Coronary Computed Tomographic Angiography Does Not Accurately Predict the Need of Coronary Revascularization in Patients with Stable Angina.
abstract: OBJECTIVE
  To evaluate the ability of coronary computed tomographic angiography (CCTA) to predict the need of coronary revascularization in symptomatic patients with stable angina who were referred to a cardiac catheterization laboratory for coronary revascularization.
  
  
  METHODS
  Pre-angiography CCTA findings were analyzed in 1846 consecutive symptomatic patients with stable angina, who were referred to a cardiac catheterization laboratory at six hospitals and were potential candidates for coronary revascularization between July 2011 and December 2013. The number of patients requiring revascularization was determined based on the severity of coronary stenosis as assessed by CCTA. This was compared to the actual number of revascularization procedures performed in the cardiac catheterization laboratory.
  
  
  RESULTS
  Based on CCTA findings, coronary revascularization was indicated in 877 (48%) and not indicated in 969 (52%) patients. Of the 877 patients indicated for revascularization by CCTA, only 600 (68%) underwent the procedure, whereas 285 (29%) of the 969 patients not indicated for revascularization, as assessed by CCTA, underwent the procedure. When the coronary arteries were divided into 15 segments using the American Heart Association coronary tree model, the sensitivity, specificity, positive predictive value, and negative predictive value of CCTA for therapeutic decision making on a per-segment analysis were 42%, 96%, 40%, and 96%, respectively.
  
  
  CONCLUSIONS
  CCTA-based assessment of coronary stenosis severity does not sufficiently differentiate between coronary segments requiring revascularization versus those not requiring revascularization. Conventional coronary angiography should be considered to determine the need of revascularization in symptomatic patients with stable angina.
authors.affiliation: Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea.
authors.forename: Ae Young
authors.initials: AY
authors.lastname: Her
authors.affiliation: Department of Internal Medicine, Myongji Hospital, Goyang, Korea.
authors.forename: Yongsung
authors.initials: Y
authors.lastname: Suh
authors.affiliation: Department of Internal Medicine, Chung-Ang University Medical Center, Seoul, Korea.
authors.forename: Hoyoun
authors.initials: H
authors.lastname: Won
authors.affiliation: Department of Internal Medicine, Myongji Hospital, Goyang, Korea.
authors.forename: Deok Kyu
authors.initials: DK
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Myongji Hospital, Goyang, Korea.
authors.forename: Yun Hyeong
authors.initials: YH
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Won
authors.initials: YW
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Gil Hospital, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Kyounghoon
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Gil Hospital, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Woong Chol
authors.initials: WC
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea.
authors.forename: Yong Hoon
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chung-Ang University Medical Center, Seoul, Korea.
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung Sun
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Byeong Keuk
authors.initials: BK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Guk
authors.initials: YG
authors.lastname: Ko
authors.affiliation: Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.|Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.|Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.|Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea. mkhong61@yuhs.ac.
authors.forename: Myeong Ki
authors.initials: MK
authors.lastname: Hong
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D014481:United States
keywords: Multidetector computed tomography; coronary artery disease; myocardial revascularization