Diagnostic performance of computed tomography coronary angiography to detect and exclude left main and/or three-vessel coronary artery disease
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- Dharampal, A.S., Papadopoulou, S.L., Rossi, A. et al. Eur Radiol (2013) 23: 2934. doi:10.1007/s00330-013-2935-6
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To determine the diagnostic performance of CT coronary angiography (CTCA) in detecting and excluding left main (LM) and/or three-vessel CAD (“high-risk” CAD) in symptomatic patients and to compare its discriminatory value with the Duke risk score and calcium score.
Materials and methods
Between 2004 and 2011, a total of 1,159 symptomatic patients (61 ± 11 years, 31 % women) with stable angina, without prior revascularisation underwent both invasive coronary angiography (ICA) and CTCA. All patients gave written informed consent for the additional CTCA. High-risk CAD was defined as LM and/or three-vessel obstructive CAD (≥50 % diameter stenosis).
A total of 197 (17 %) patients had high-risk CAD as determined by ICA. The sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios of CTCA were 95 % (95 % CI 91–97 %), 83 % (80–85 %), 53 % (48–58 %), 99 % (98–99 %), 5.47 and 0.06, respectively. CTCA provided incremental value (AUC 0.90, P < 0.001) in the discrimination of high-risk CAD compared with the Duke risk score and calcium score.
CTCA accurately excludes high-risk CAD in symptomatic patients. The detection of high-risk CAD is suboptimal owing to the high percentage (47 %) of overestimation of high-risk CAD. CTCA provides incremental value in the discrimination of high-risk CAD compared with the Duke risk score and calcium score.
• Computed tomography coronary angiography (CTCA) accurately excludes high-risk coronary artery disease.
• CTCA overestimates high-risk coronary artery disease in 47 %.
• CTCA discriminates high-risk CAD better than clinical evaluation and coronary calcification.
KeywordsComputed tomography coronary angiographyDiagnostic performanceLeft main and/or three-vessel CAD“High-risk” CADCalcium score, coronary calcificationDuke risk score, clinical evaluation
Area under the receiver operating characteristic curve
Coronary artery disease
Computed tomography coronary angiography
Invasive coronary angiography
Left anterior descending artery
Positive predictive value
Negative predictive value
Right coronary artery
Quantitative coronary angiography