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
Cardiac

Abstract

Objectives

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).

Results

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.

Conclusions

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.

Keywords

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 

Abbreviations

1VD

One-vessel CAD

2VD

Two-vessel CAD

3VD

Three-vessel CAD

AUC

Area under the receiver operating characteristic curve

CAD

Coronary artery disease

CTCA

Computed tomography coronary angiography

CX

Circumflex

DSCT

Dual-source CT

ECG

Electrocardiogram

HR

Heart rate

ICA

Invasive coronary angiography

LAD

Left anterior descending artery

LM

Left main

NS

Not significant

PPV

Positive predictive value

NPV

Negative predictive value

RCA

Right coronary artery

SN

Sensitivity

SP

Specificity

SSCT

Single-source CT

QCA

Quantitative coronary angiography

Notes

Acknowledgements

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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