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Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data and review of multicentre trials

Accuratezza diagnostica dell’angiografia coronarica con tomografia computerizzata a 64 strati in una ampia popolazione di pazienti non rivascolarizzati: dati di registro e review dei trials multicentrici

  • Cardiac Radiology/Cardioradiologia
  • Published:
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Abstract

Purpose

This study was undertaken to evaluate the diagnostic accuracy of computed tomography coronary angiography (CT-CA) for the detection of significant coronary artery stenosis (≥50% lumen reduction) compared with conventional coronary angiography (CCA) in a registry and to review major multicentre trials.

Materials and methods

A total of 1,372 patients (882 men, 490 women; mean age 59.3±11.9 years) in sinus rhythm were studied with CT-CA (64-slice technology) and CCA. The diagnostic accuracy of CT-CA was evaluated against quantitative CCA as a reference standard for coronary artery stenosis. Positive and negative likelihood ratios and inter- and intraobserver agreement were calculated.

Results

The prevalence of disease was 53%. CCA demonstrated the absence of significant coronary artery disease in 46.6% (639/1372), single-vessel disease in 24.7% (337/1372) and multivessel disease in 28.9% (396/1372) of patients. In per-patient analysis sensitivity, specificity and positive and negative predictive value of CT-CA were 99% [confidence interval (CI) 97–99], 92% (CI 89–94), 94% (CI 91–95) and 99% (CI 97–99), respectively. Per-patient and per-segment likelihood ratios (LR+=12.4 and LR−=0.011; LR+=18.3 and LR−=0.064, respectively), were good. Inter- and intraobserver variability was 0.78 and 0.85, respectively.

Conclusions

CT-CA is a reliable diagnostic modality both in terms of sensitivity and negative predictive value. Differences in trial results are also due to the different parameters used for patient inclusion.

Riassunto

Obiettivo

Obiettivo di questo lavoro è stato valutare l’accuratezza diagnostica dell’angiografia coronarica non invasiva con tomografia computerizzata (CT-CA) a 64 strati nell’individuazione delle stenosi coronariche significative (riduzione del lume coronarico ≥50%) confrontata con la coronarografia convenzionale (CAG) in un registro e revisionare i risultati dei trials multicentrici.

Materiali e metodi

Sono stati studiati 1372 pazienti (882 uomini, 490 donne, età media 59,3±11,9 anni) in ritmo cardiaco sinusale con CT-CA (tecnologia 64 strati) e CAG. La CT-CA è stata eseguita secondo i protocolli comunemente utilizzati. L’accuratezza diagnostica è stata calcolata utilizzando la CAG come standard di riferimento. Sono state calcolate l’accuratezza diagnostica, i likelihood ratio positivo e negativo (LR+ e LR−) e la variabilità inter- ed intra-osservatore.

Risultati

La prevalenza di malattia nella popolazione era del 53%. Il 46,6% (639/1372) mostravano coronarie indenni o con lesioni che determinavano stenosi <50%, il 24,7% (337/1372) mostrano malattia critica di un solo vaso, ed il 28,9% (396/1372) dei pazienti mostrava coronaropatia critica multivasale. Nell’analisi per paziente la sensibilità, specificità, valore predittivo positivo e negativo della CT-CA sono risultati 99% (intervallo di confidenza [IC] 97–99), 92% (IC 89–94), 94% (IC 91–95), 99% (IC 97–99), rispettivamente. I likelihood ratio per paziente (LR+=12,4 e LR−=0,011) e per segmento (LR+=18,3 e LR−=0,064), sono risultati ottimali. Le variabilità inter- ed intra-osservatore sono risultate 0,78 e 0,85, rispettivamente.

Conclusioni

La CT-CA è una metodica diagnostica affidabile sia per l’elevata sensibilità che per l’elevato valore predittivo negativo. I risultati dei trials sono variabili anche alla luce dei parametri principali di inclusione utilizzati.

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Authors and Affiliations

  1. Dipartimento di Radiologia e del Cardio-Polmonare, Azienda Ospedaliero-Universitaria di Parma, c/o Piastra Tecnica, Piano 0, Via Gramsci 14, 43100, Parma, Italy

    E. Maffei, A. Palumbo, C. Martini, S. Seitun & F. Cademartiri

  2. Dipartimento di Radiologia e Cardiologia, Erasmus Medical Center, Rotterdam, The Netherlands

    A. Palumbo, C. Martini, W. Meijboom, A. Weustink, N. Mollet, G. P. Krestin & F. Cademartiri

  3. Dipartimento di Radiologia e Cardiologia, Ospedale San Gennaro, Napoli, Italy

    C. Tedeschi

  4. CPC — Centro Prevenzione Cardiovascolare, Ospedale San Raffaele, Milano, Italy

    P. Spagnolo

  5. Dipartimento di Radiologia e Cardiologia, Azienda ASL, Carrara, Italy

    A. Zuccarelli & T. Torri

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  1. E. Maffei
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  2. A. Palumbo
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Correspondence to F. Cademartiri.

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Maffei, E., Palumbo, A., Martini, C. et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data and review of multicentre trials. Radiol med 115, 368–384 (2010). https://doi.org/10.1007/s11547-009-0492-5

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  • DOI: https://doi.org/10.1007/s11547-009-0492-5

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