Diagnostic performance of 320-slice computed tomography coronary angiography for symptomatic patients in clinical practice.
OBJECTIVE
Multi-slice computed tomography (MSCT) coronary angiography has been reported as an effective alternative to invasive conventional coronary angiography (CCA) for the diagnosis of coronary artery disease (CAD). However, in previous reports, the diagnostic accuracy of MSCT has not been significant enough to be of benefit in symptomatic patients. The aim of this study was to identify the usefulness of 320-slice computed tomography coronary angiography (320-CTA) for symptomatic patients in terms of the diagnostic accuracy of 320-CTA and the prevalence of vasospastic angina pectoris (VSAP) within the study cohort.


METHODS
We retrospectively analyzed 513 consecutive symptomatic patients with suspected CAD who had undergone 320-CTA and CCA. We determined the diagnostic accuracy of 320-CTA using CCA as the reference standard. Ergonovine provocation tests were performed on patients without significant coronary artery stenosis on CCA.


RESULTS
Of the total cohort of 513 symptomatic patients, 39% had obstructive CAD. The patient based analysis of the accuracy of 320-CTA showed a sensitivity of 91.0%, a specificity of 71.0%, a positive predictive value of 66.5%, and a negative predictive value of 92.5%. Of the 314 symptomatic patients who did not have significant coronary artery stenosis on CCA, 58 (18%) were diagnosed with VSAP using ergonovine provocation tests.


CONCLUSIONS
The negative and positive predictive values indicate that 320-CTA cannot replace CCA for symptomatic patients. Indeed, a combination of CCA and ergonovine provocation tests should be taken into consideration for symptomatic patients.
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan. Electronic address: futoshi-yamanaka@nifty.com.
Futoshi
F
Yamanaka
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Koki
K
Shishido
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Tomoki
T
Ochiai
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Noriaki
N
Moriyama
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Kazuki
K
Tobita
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Tomoyuki
T
Tani
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Kyosuke
K
Furuhashi
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Kazuya
K
Sugitatsu
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Daisuke
D
Hachinohe
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Tadashi
T
Wada
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Shingo
S
Mizuno
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Hidetaka
H
Suenaga
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Yutaka
Y
Tanaka
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Masato
M
Murakami
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Junya
J
Matsumi
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Saeko
S
Takahashi
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Takeshi
T
Akasaka
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Shinji
S
Tanaka
Department of Cardiology and Catheterization Laboratory, Shonankamakura General Hospital, Kamakura, Japan.
Shigeru
S
Saito
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
Angina pectoris; Computed tomography; Coronary vasospasm; X-ray