CLINICAL RESEARCH: CLINICAL TRIAL
Diagnostic Accuracy of 64-Slice Computed Tomography Coronary AngiographyA Prospective, Multicenter, Multivendor Study
W. Bob Meijboom, MD*, ,
Matthijs F.L. Meijs, MD ,||,
Joanne D. Schuijf, MD, PhD¶,#,
Maarten J. Cramer, MD, PhD,
Nico R. Mollet, MD, PhD*,,
Carlos A.G. van Mieghem, MD*,,
Koen Nieman, MD, PhD*,,
Jacob M. van Werkhoven, MD||,#,
Gabija Pundziute, MD||,#,
Annick C. Weustink, MD*,,
Alexander M. de Vos, MD,||,
Francesca Pugliese, MD*,,
Benno Rensing, MD, PhD**,
J. Wouter Jukema, MD, PhD¶,
Jeroen J. Bax, MD, PhD¶,
Mathias Prokop, MD, PhD||,
Pieter A. Doevendans, MD, PhD,
Myriam G.M. Hunink, MD, PhD, ,
Gabriel P. Krestin, MD, PhD and
Pim J. de Feyter, MD, PhD*,,*
* Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
Department of Cardiology, Utrecht University Medical Center, Utrecht, the Netherlands
|| Department of Radiology, Utrecht University Medical Center, Utrecht, the Netherlands
¶ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
# Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
** Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
Manuscript received May 28, 2008;
revised manuscript received August 21, 2008,
accepted August 27, 2008.
* Reprint requests and correspondence: Dr. Pim J. de Feyter, Erasmus Medical Center, Department of Cardiology and Radiology, Room Hs 227, Gravendijkwal 230, P.O. Box 2040, 3015 GD Rotterdam, the Netherlands (Email: p.j.defeyter{at}erasmusmc.nl).
Objectives: This study sought to determine the diagnostic accuracy of 64-slice computed tomographic coronary angiography (CTCA) to detect or rule out significant coronary artery disease (CAD).
Background: CTCA is emerging as a noninvasive technique to detect coronary atherosclerosis.
Methods: We conducted a prospective, multicenter, multivendor study involving 360 symptomatic patients with acute and stable anginal syndromes who were between 50 and 70 years of age and were referred for diagnostic conventional coronary angiography (CCA) from September 2004 through June 2006. All patients underwent a nonenhanced calcium scan and a CTCA, which was compared with CCA. No patients or segments were excluded because of impaired image quality attributable to either coronary motion or calcifications. Patient-, vessel-, and segment-based sensitivities and specificities were calculated to detect or rule out significant CAD, defined as  50% lumen diameter reduction.
Results: The prevalence among patients of having at least 1 significant stenosis was 68%. In a patient-based analysis, the sensitivity for detecting patients with significant CAD was 99% (95% confidence interval [CI]: 98% to 100%), specificity was 64% (95% CI: 55% to 73%), positive predictive value was 86% (95% CI: 82% to 90%), and negative predictive value was 97% (95% CI: 94% to 100%). In a segment-based analysis, the sensitivity was 88% (95% CI: 85% to 91%), specificity was 90% (95% CI: 89% to 92%), positive predictive value was 47% (95% CI: 44% to 51%), and negative predictive value was 99% (95% CI: 98% to 99%).
Conclusions: Among patients in whom a decision had already been made to obtain CCA, 64-slice CTCA was reliable for ruling out significant CAD in patients with stable and unstable anginal syndromes. A positive 64-slice CTCA scan often overestimates the severity of atherosclerotic obstructions and requires further testing to guide patient management.
Key Words: coronary artery disease • computed tomography • coronary angiography • prospective • multicenter
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | CCA = conventional coronary angiogram/angiography | | CT = computed tomographic/tomography | | CTCA = computed tomographic coronary angiogram/angiography | | NPV = negative predictive value | | PPV = positive predictive value | | QCA = quantitative coronary angiogram/angiography |
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