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
|
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 |
|
Related Articles
-
Limitations of Computed Tomography Coronary Angiography
- Steven E. Nissen
J. Am. Coll. Cardiol. 2008 52: 2145-2147.
[Full Text]
[PDF]
-
Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 52: A29.
[Full Text]
[PDF]
This article has been cited by other articles:

|
 |

|
 |
 
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.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
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.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. T. Wijesekera, M. K. Duncan, and S. P. G. Padley
X-ray computed tomography of the heart
Br. Med. Bull.,
November 17, 2009;
(2009)
ldp043v1.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
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.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
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.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
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.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Achenbach
Stress computed tomography myocardial perfusion: steps, questions, and layers.
J. Am. Coll. Cardiol.,
September 15, 2009;
54(12):
1085 - 1087.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. Knuuti
Integrated positron emission tomography/computed tomography (PET/CT) in coronary disease
Heart,
September 1, 2009;
95(17):
1457 - 1463.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. J. de Feyter
Reply
J. Am. Coll. Cardiol.,
June 23, 2009;
53(25):
2406 - 2406.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. R. Conti
Coronary Angiography: Catheter Based or Computed Tomography Based
J. Am. Coll. Cardiol.,
June 23, 2009;
53(25):
2405 - 2406.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
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.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
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.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
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.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
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.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. E. Nissen
Reply
J. Am. Coll. Cardiol.,
May 12, 2009;
53(19):
1826 - 1827.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
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]
|
 |
|

|
 |

|
 |
 
A. C. McCulloch, S. Paulin, S. K. Gerard, G. Karthikeyan, G. Vorobiof, W. M. Fogarty Jr., J. A.C. Lima, J. M. Miller, the CORE 64 Investigators, J. Walsh, et al.
Coronary Angiography by 64-Row CT
N. Engl. J. Med.,
May 7, 2009;
360(19):
2027 - 2031.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. K. Min and D. Berman
Anatomic and Functional Assessment of Coronary Artery Disease: Convergence of 2 Aims in a Single Setting
Circ Cardiovasc Imaging,
May 1, 2009;
2(3):
163 - 165.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. V. Raman
Coronary Artery or Myocyte: Wherein Lies the Diagnosis?
Circ Cardiovasc Imaging,
May 1, 2009;
2(3):
166 - 168.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
U. Hoffmann and F. Bamberg
Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department
Circ Cardiovasc Imaging,
May 1, 2009;
2(3):
251 - 263.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. C. Hendel
Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?: CT Coronary Angiography Is the Most Accurate and Effective Noninvasive Imaging Tool for Evaluating Patients Presenting With Chest Pain to the Emergency Department: Antagonist Viewpoint
Circ Cardiovasc Imaging,
May 1, 2009;
2(3):
264 - 275.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. J. Einstein
Radiation Protection of Patients Undergoing Cardiac Computed Tomographic Angiography
JAMA,
February 4, 2009;
301(5):
545 - 547.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. J. de Feyter, S. Achenbach, and K. Nieman
CHAPTER 6 Cardiovascular Computed Tomography
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. E. Nissen
Limitations of computed tomography coronary angiography.
J. Am. Coll. Cardiol.,
December 16, 2008;
52(25):
2145 - 2147.
[Full Text]
[PDF]
|
 |
|
|