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J Am Coll Cardiol, 2008; 52:2135-2144, doi:10.1016/j.jacc.2008.08.058
© 2008 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CLINICAL TRIAL

Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography

A Prospective, Multicenter, Multivendor Study

W. Bob Meijboom, MD*,{dagger}, Matthijs F.L. Meijs, MD§,||, Joanne D. Schuijf, MD, PhD,#, Maarten J. Cramer, MD, PhD§, Nico R. Mollet, MD, PhD*,{dagger}, Carlos A.G. van Mieghem, MD*,{dagger}, Koen Nieman, MD, PhD*,{dagger}, Jacob M. van Werkhoven, MD||,#, Gabija Pundziute, MD||,#, Annick C. Weustink, MD*,{dagger}, Alexander M. de Vos, MD§,||, Francesca Pugliese, MD*,{dagger}, 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{dagger},{ddagger}, Gabriel P. Krestin, MD, PhD{dagger} and Pim J. de Feyter, MD, PhD*,{dagger},*

* Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
{dagger} Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
{ddagger} 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

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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WRITING COMMITTEE MEMBERS, D. B. Mark, D. S. Berman, M. J. Budoff, J. J. Carr, T. C. Gerber, H. S. Hecht, M. A. Hlatky, J. M. Hodgson, M. S. Lauer, et al.
ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents
Circulation, June 8, 2010; 121(22): 2509 - 2543.
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 Eur Heart JHome page
S. Achenbach and P. Raggi
Imaging of coronary atherosclerosis by computed tomography
Eur. Heart J., June 2, 2010; 31(12): 1442 - 1448.
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 ANN INTERN MEDHome page
A. C. Weustink, N. R. Mollet, L. A. Neefjes, W. B. Meijboom, T. W. Galema, C. A. van Mieghem, S. Kyrzopoulous, R. N. Eu, K. Nieman, F. Cademartiri, et al.
Diagnostic Accuracy and Clinical Utility of Noninvasive Testing for Coronary Artery Disease
Ann Intern Med, May 18, 2010; 152(10): 630 - 639.
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 Eur Heart JHome page
J. K. Min, F. Y. Lin, A. M. Dunning, A. Delago, J. Egan, L. J. Shaw, D. S. Berman, and T. Q. Callister
Incremental prognostic significance of left ventricular dysfunction to coronary artery disease detection by 64-detector row coronary computed tomographic angiography for the prediction of all-cause mortality: results from a two-centre study of 5330 patients
Eur. Heart J., May 2, 2010; 31(10): 1212 - 1219.
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 J Am Coll Cardiol ImgHome page
T. M. LaBounty, R. J. Kim, F. Y. Lin, M. J. Budoff, J. W. Weinsaft, and J. K. Min
Diagnostic Accuracy of Coronary Computed Tomography Angiography as Interpreted on a Mobile Handheld Phone Device
J. Am. Coll. Cardiol. Img., May 1, 2010; 3(5): 482 - 490.
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 Am. J. Roentgenol.Home page
E. J. Halpern, M. P. Savage, D. L. Fischman, and D. C. Levin
Cost-Effectiveness of Coronary CT Angiography in Evaluation of Patients Without Symptoms Who Have Positive Stress Test Results
Am. J. Roentgenol., May 1, 2010; 194(5): 1257 - 1262.
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 J Am Coll CardiolHome page
J. K. Min, L. J. Shaw, and D. S. Berman
The Present State of Coronary Computed Tomography Angiography: A Process in Evolution
J. Am. Coll. Cardiol., March 9, 2010; 55(10): 957 - 965.
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 Br Med BullHome page
N. T. Wijesekera, M. K. Duncan, and S. P. G. Padley
X-ray computed tomography of the heart
Br. Med. Bull., March 1, 2010; 93(1): 49 - 67.
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 HeartHome page
J. M. van Werkhoven, M. W. Heijenbrok, J. D. Schuijf, J. W. Jukema, E. E. van der Wall, J. H. M. Schreur, and J. J. Bax
Combined non-invasive anatomical and functional assessment with MSCT and MRI for the detection of significant coronary artery disease in patients with an intermediate pre-test likelihood
Heart, March 1, 2010; 96(6): 425 - 431.
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 HeartHome page
W. C. Wood
Non-invasive anatomy and physiology: the new 'gold standard'?
Heart, March 1, 2010; 96(6): 411 - 412.
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 Mayo Clin Proc.Home page
M. C. Kontos, D. B. Diercks, and J. D. Kirk
Emergency Department and Office-Based Evaluation of Patients With Chest Pain
Mayo Clin. Proc., March 1, 2010; 85(3): 284 - 299.
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 J Am Coll CardiolHome page
R. J. Gibbons, P. A. Araoz, and E. E. Williamson
The Year in Cardiac Imaging
J. Am. Coll. Cardiol., February 2, 2010; 55(5): 483 - 495.
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 ANN INTERN MEDHome page
G. M. Schuetz, N. M. Zacharopoulou, P. Schlattmann, and M. Dewey
Meta-analysis: Noninvasive Coronary Angiography Using Computed Tomography Versus Magnetic Resonance Imaging
Ann Intern Med, February 2, 2010; 152(3): 167 - 177.
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 RadiologyHome page
J. A. Rocha-Filho, R. Blankstein, L. D. Shturman, H. G. Bezerra, D. R. Okada, I. S. Rogers, B. Ghoshhajra, U. Hoffmann, G. Feuchtner, W. S. Mamuya, et al.
Incremental Value of Adenosine-induced Stress Myocardial Perfusion Imaging with Dual-Source CT at Cardiac CT Angiography
Radiology, February 1, 2010; 254(2): 410 - 419.
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 RadiologyHome page
J. G. J. Groothuis, A. M. Beek, S. L. Brinckman, M. R. Meijerink, S. C. Koestner, R. Nijveldt, M. J. W. Gotte, M. B. M. Hofman, C. van Kuijk, and A. C. van Rossum
Low to Intermediate Probability of Coronary Artery Disease: Comparison of Coronary CT Angiography with First-Pass MR Myocardial Perfusion Imaging
Radiology, February 1, 2010; 254(2): 384 - 392.
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 J Am Coll CardiolHome page
A. V.G. Bruschke, W. C. Sheldon, E. K. Shirey, and W. L. Proudfit
A Half Century of Selective Coronary Arteriography
J. Am. Coll. Cardiol., December 1, 2009; 54(23): 2139 - 2144.
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 RadiologyHome page
T. S. S. Genders, W. B. Meijboom, M. F. L. Meijs, J. D. Schuijf, N. R. Mollet, A. C. Weustink, F. Pugliese, J. J. Bax, M. J. Cramer, G. P. Krestin, et al.
CT Coronary Angiography in Patients Suspected of Having Coronary Artery Disease: Decision Making from Various Perspectives in the Face of Uncertainty
Radiology, December 1, 2009; 253(3): 734 - 744.
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 RadiologyHome page
G. Bastarrika, Y. S. Lee, W. Huda, B. Ruzsics, P. Costello, and U. J. Schoepf
CT of Coronary Artery Disease
Radiology, November 1, 2009; 253(2): 317 - 338.
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 HeartHome page
K Nieman, T Galema, A Weustink, L Neefjes, A Moelker, P Musters, R de Visser, N Mollet, H Boersma, and P J de Feijter
Computed tomography versus exercise electrocardiography in patients with stable chest complaints: real-world experiences from a fast-track chest pain clinic
Heart, October 15, 2009; 95(20): 1669 - 1675.
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 HeartHome page
J M van Werkhoven, O Gaemperli, J D Schuijf, J W Jukema, L J Kroft, S Leschka, H Alkadhi, I Valenta, G Pundziute, A de Roos, et al.
Multislice computed tomography coronary angiography for risk stratification in patients with an intermediate pretest likelihood
Heart, October 1, 2009; 95(19): 1607 - 1611.
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 J Am Coll CardiolHome page
S. Achenbach
Stress Computed Tomography Myocardial Perfusion: Steps, Questions, and Layers
J. Am. Coll. Cardiol., September 15, 2009; 54(12): 1085 - 1087.
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 HeartHome page
J. Knuuti
Integrated positron emission tomography/computed tomography (PET/CT) in coronary disease
Heart, September 1, 2009; 95(17): 1457 - 1463.
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 J Am Coll CardiolHome page
P. J. de Feyter
Reply
J. Am. Coll. Cardiol., June 23, 2009; 53(25): 2406 - 2406.
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 J Am Coll CardiolHome page
C. R. Conti
Coronary Angiography: Catheter Based or Computed Tomography Based
J. Am. Coll. Cardiol., June 23, 2009; 53(25): 2405 - 2406.
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 J Am Coll Cardiol ImgHome page
S. Achenbach, V. Dilsizian, C. M. Kramer, and W. A. Zoghbi
The Year in Coronary Artery Disease
J. Am. Coll. Cardiol. Img., June 1, 2009; 2(6): 774 - 786.
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 J Am Coll Cardiol IntvHome page
D. S. Berman and J. K. Min
Can Coronary Computed Tomographic Angiography Trigger Coronary Revascularization?: Questioning the Appropriateness of the Question
J. Am. Coll. Cardiol. Intv., June 1, 2009; 2(6): 558 - 560.
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 J Am Coll CardiolHome page
J. K. Min and D. S. Berman
Placing Computed Tomography Coronary Angiography in Perspective
J. Am. Coll. Cardiol., May 12, 2009; 53(19): 1824 - 1824.
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 J Am Coll CardiolHome page
W. B. Meijboom, M. F.L. Meijs, J. D. Schuijf, M. J. Cramer, N. R. Mollet, C. A.G. van Mieghem, K. Nieman, J. M. van Werkhoven, G. Pundziute, A. C. Weustink, et al.
Reply
J. Am. Coll. Cardiol., May 12, 2009; 53(19): 1825 - 1826.
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 J Am Coll CardiolHome page
S. E. Nissen
Reply
J. Am. Coll. Cardiol., May 12, 2009; 53(19): 1826 - 1827.
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 J Am Coll CardiolHome page
E. D. Nicol, J. Stirrup, S. P.G. Padley, and M. B. Rubens
Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography: A Flawed Comparison
J. Am. Coll. Cardiol., May 12, 2009; 53(19): 1824 - 1825.
[Full Text] [PDF]


 
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