Diagnostic Performance of 64-Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery DiseaseResults From the Prospective Multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) Trial
Matthew J. Budoff, MD*,*,
David Dowe, MD ,
James G. Jollis, MD ,
Michael Gitter, MD ,
John Sutherland, MD||,
Edward Halamert, MD¶,
Markus Scherer, MD#,
Raye Bellinger, MD**,
Arthur Martin, MD,
Robert Benton, MD,
Augustin Delago, MD and
James K. Min, MD
* Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
Department of Radiology, Atlantic Medical Imaging, Atlantic City, New Jersey
Department of Medicine, Duke University Medical Center, Durham, North Carolina
Appleton Cardiology, Appleton, Wisconsin
|| Arizona Heart Institute, Phoenix, Arizona
¶ Indiana Heart Hospital, Indianapolis, Indiana
# Northeast Medical Center, Concord, North Carolina
** Sacramento Heart and Vascular Research Center, Sacramento, California
Southern Heart Center, Hattiesburg, Mississippi
Capital Cardiology Associates, Albany, New York
Departments of Medicine and Radiology, Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, New York
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Figure 1 Computed Tomographic Angiogram and Invasive Angiogram Demonstrating Significant Left Anterior Descending Artery Disease
(A) Right anterior oblique orientation of left anterior descending artery with quantitative coronary angiography. (B) Multiplanar reformation and short-axis cross-sectional view (inset) of the left anterior descending artery demonstrating obstructive coronary artery stenosis. (C) Curved multiplanar reformat of the left anterior descending artery demonstrating obstructive coronary artery stenosis. (D) Volume-rendered view of the left anterior descending artery. Arrows indicate the significant stenosis present on the computed tomographic angiogram and corresponding invasive angiogram.
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Figure 2 Computed Tomographic Angiogram Demonstrating Obstructive Disease of the Left Circumflex Artery With Quantitative Angiography Correlation
(A) Right anterior oblique orientation of the left circumflex artery with quantitative coronary angiography. (B) Curved multiplanar reformation and short-axis cross-sectional view (inset) of the left circumflex artery demonstrating obstructive coronary artery stenosis. (C) Multiplanar reformation and short-axis cross-sectional view (inset) of the left circumflex artery demonstrating obstructive coronary artery stenosis. Arrows indicate significant stenosis present on the computed tomographic angiogram and corresponding invasive angiogram.
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Figure 3 ROC Curve Evaluating Diagnostic Accuracy of CCTA Compared With Invasive Angiogram
Receiver-operating characteristic (ROC) curve for identification of patients by coronary computed tomographic angiography (CCTA) with  70% coronary artery stenosis by quantitative coronary angiography. The points on the plot represent the 6 categories of interpretation for CCTA used in this study: 0 = 100% stenosis; 1 = 70% to 99% stenosis; 2 = 50% to 69% stenosis; 3 = 30% to 49% stenosis; 4 = <30% stenosis; and 5 = no stenosis. The ROC shows us the degree to which we predict disease/no disease of 70% stenosis by invasive angiography. AUC = area under the receiver-operating characteristic curve; CI = confidence interval.
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