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Assessment of Native Coronary Artery Disease

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Atlas of Cardiovascular Computed Tomography

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Abstract

The assessment of native coronary artery disease is one of the major applications of cardiac CT. Coronary CT angiography (coronary CTA) has high accuracy to identify coronary artery stenoses. Of importance, sensitivity approaches 100%, so that the presence of relevant coronary artery stenoses can be ruled out with a high degree of confidence, making further work-up unnecessary. In a meta-analysis of 30 studies with a total of 3722 patients, Menke et al. [1] demonstrated a sensitivity of 95.6% and specificity of 81.5% for coronary CTA performed with systems of at least 64 slices, in comparison with invasive coronary angiography. Accuracy was significantly lower for systems with fewer than 64 slices. Heart rate also influenced accuracy, with significantly higher accuracy for heart rates less than 62 beats per minute, compared with higher heart rates. Importantly, the high sensitivity of coronary CT angiography translates to an excellent ability to rule out coronary artery stenoses: the negative likelihood ratio for systems with at least 64 slices in the above-named study was 0.022. As a consequence of its high accuracy in ruling out coronary artery stenoses, coronary CTA has been incorporated into several guidelines published by US and European professional societies. Its use is generally endorsed as an alternative to other forms of noninvasive testing when the pretest likelihood is relatively low and patient characteristics make a fully diagnostic study very likely. It is also recommended that coronary CTA be considered when other noninvasive forms of testing are inconclusive [2–6].

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Authors and Affiliations

  1. Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany

    Stephan S. Achenbach MD

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  1. Stephan S. Achenbach MD
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Correspondence to Stephan S. Achenbach MD .

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Editors and Affiliations

  1. Los Angeles Biomedical Research Institute, UCLA, Torrance, California, USA

    Matthew J. Budoff

  2. Department of Cardiology, Universitätsklinikum Erlangen, Erlangen, Germany

    Stephan S. Achenbach

  3. Mount Sinai Hospital, New York City, New York, USA

    Harvey S. Hecht

  4. Department of Cardiology , Mount Sinai Hospital, New York, New York, USA

    Jagat Narula

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Achenbach, S.S. (2018). Assessment of Native Coronary Artery Disease. In: Budoff, M., Achenbach, S., Hecht, H., Narula, J. (eds) Atlas of Cardiovascular Computed Tomography. Springer, London. https://doi.org/10.1007/978-1-4471-7357-1_5

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  • DOI: https://doi.org/10.1007/978-1-4471-7357-1_5

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