Diagnostic performance of computed tomography coronary angiography to detect and exclude left main and/or three-vessel coronary artery disease
- 398 Downloads
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 angiography Diagnostic performance Left main and/or three-vessel CAD “High-risk” CAD Calcium score, coronary calcification Duke 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
- 7.Weiner DA, Ryan TJ, McCabe CH et al (1987) Value of exercise testing in determining the risk classification and the response to coronary artery bypass grafting in three-vessel coronary artery disease: a report from the Coronary Artery Surgery Study (CASS) registry. Am J Cardiol 60:262–266PubMedCrossRefGoogle Scholar
- 11.Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52:1724–1732PubMedCrossRefGoogle Scholar
- 12.Taylor AJ, Cerqueira M, Hodgson JM et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 56:1864–1894PubMedCrossRefGoogle Scholar
- 14.Meijboom WB, Van Mieghem CA, van Pelt N et al (2008) Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol 52:636–643PubMedCrossRefGoogle Scholar
- 33.Min JK, Dunning A, Lin FY et al (2011) Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. J Am Coll Cardiol 58:849–860PubMedCrossRefGoogle Scholar
- 34.Shaw LJ, Mieres JH, Hendel RH et al (2011) Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial. Circulation 124:1239–1249PubMedCrossRefGoogle Scholar
- 41.Ragosta M, Bishop AH, Lipson LC et al (2007) Comparison between angiography and fractional flow reserve versus single-photon emission computed tomographic myocardial perfusion imaging for determining lesion significance in patients with multivessel coronary disease. Am J Cardiol 99:896–902PubMedCrossRefGoogle Scholar
- 46.Koo BK, Erglis A, Doh JH et al (2011) Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol 58:1989–1997PubMedCrossRefGoogle Scholar