European Radiology

, Volume 23, Issue 11, pp 2934–2943 | Cite as

Diagnostic performance of computed tomography coronary angiography to detect and exclude left main and/or three-vessel coronary artery disease

  • Anoeshka S. Dharampal
  • Stella L. Papadopoulou
  • Alexia Rossi
  • W. Bob Meijboom
  • Annick Weustink
  • Marcel Dijkshoorn
  • Koen Nieman
  • Eric H. Boersma
  • Pim J. de Feijter
  • Gabriel P. Krestin



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.

Key Points

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.


Computed tomography coronary angiography Diagnostic performance Left main and/or three-vessel CAD “High-risk” CAD Calcium score, coronary calcification Duke risk score, clinical evaluation 



One-vessel CAD


Two-vessel CAD


Three-vessel CAD


Area under the receiver operating characteristic curve


Coronary artery disease


Computed tomography coronary angiography




Dual-source CT




Heart rate


Invasive coronary angiography


Left anterior descending artery


Left main


Not significant


Positive predictive value


Negative predictive value


Right coronary artery






Single-source CT


Quantitative coronary angiography



Parts of this single-centre cardiac database have been used in previous studies [14, 15, 16, 17, 18].


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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Anoeshka S. Dharampal
    • 1
    • 2
  • Stella L. Papadopoulou
    • 1
    • 2
  • Alexia Rossi
    • 1
    • 2
  • W. Bob Meijboom
    • 1
    • 2
  • Annick Weustink
    • 1
    • 2
  • Marcel Dijkshoorn
    • 1
  • Koen Nieman
    • 1
    • 2
  • Eric H. Boersma
    • 2
  • Pim J. de Feijter
    • 1
    • 2
  • Gabriel P. Krestin
    • 1
  1. 1.Department of RadiologyErasmus MCRotterdamThe Netherlands
  2. 2.Department of CardiologyErasmus MCRotterdamThe Netherlands

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