CLINICAL RESEARCH: CARDIAC IMAGING
64-Slice Computed Tomography Coronary Angiography in Patients With High, Intermediate, or Low Pretest Probability of Significant Coronary Artery Disease
W. Bob Meijboom, MD*, ,
Carlos A.G. van Mieghem, MD*,,
Nico R. Mollet, MD, PhD*,,
Francesca Pugliese, MD*,,
Annick C. Weustink, MD*,,
Niels van Pelt, MD*,,
Filippo Cademartiri, MD, PhD,
Koen Nieman, MD, PhD*,
Eric Boersma, MSc, PhD*,
Peter de Jaegere, MD, PhD*,
Gabriel P. Krestin, MD, PhD and
Pim J. de Feyter, MD, PhD, FACC*,,*
* Department of Cardiology, Thoraxcenter, Rotterdam, the Netherlands
Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Manuscript received March 14, 2007;
revised manuscript received July 2, 2007,
accepted July 10, 2007.
* Reprint requests and correspondence: Dr. Pim J. de Feyter, Erasmus Medical Center, Department of Cardiology and Radiology, Room Hs 207, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. (Email: p.j.defeyter{at}erasmusmc.nl).
Objectives: We assessed the usefulness of 64-slice computed tomography coronary angiography (CTCA) to detect or rule out coronary artery disease (CAD) in patients with various estimated pretest probabilities of CAD.
Background: The pretest probability of the presence of CAD may impact the diagnostic performance of CTCA.
Methods: Sixty-four-slice CTCA (Sensation 64, Siemens, Forchheim, Germany) was performed in 254 symptomatic patients. Patients with heart rates  65 beats/min received beta-blockers before CTCA. The pretest probability for significant CAD was estimated by type of chest discomfort, age, gender, and traditional risk factors and defined as high (71%), intermediate (31% to 70%), and low ( 30%). Significant CAD was defined as the presence of at least 1 50% coronary stenosis on quantitative coronary angiography, which was the standard of reference. No coronary segments were excluded from analysis.
Results: The estimated pretest probability of CAD in the high (n = 105), intermediate (n = 83), and low (n = 66) groups was 87%, 53%, and 13%, respectively. The diagnostic performance of the computed tomography (CT) scan was different in the 3 subgroups. The estimated post-test probability of the presence of significant CAD after a negative CT scan was 17%, 0%, and 0% and after a positive CT scan was 96%, 88%, and 68%, respectively.
Conclusions: Computed tomography coronary angiography is useful in symptomatic patients with a low or intermediate estimated pretest probability of having significant CAD, and a negative CT scan reliably rules out the presence of significant CAD. Computed tomography coronary angiography does not provide additional relevant diagnostic information in symptomatic patients with a high estimated pretest probability of CAD.
|
Abbreviations and Acronyms
| | CAD = coronary artery disease | | CCA = conventional coronary angiogram | | CI = confidence interval | | CT = computed tomography | | CTCA = computed tomography coronary angiography | | LR = likelihood ratio | | QCA = quantitative coronary angiography |
|
Related Article
-
Inside This Issue of JACC
J. Am. Coll. Cardiol. 2007 50: A37-A38.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
A. Arbab-Zadeh, J. M. Miller, C. E. Rochitte, M. Dewey, H. Niinuma, I. Gottlieb, N. Paul, M. E. Clouse, E. P. Shapiro, J. Hoe, et al.
Diagnostic Accuracy of Computed Tomography Coronary Angiography According to Pre-Test Probability of Coronary Artery Disease and Severity of Coronary Arterial Calcification: The CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) International Multicenter Study
J. Am. Coll. Cardiol.,
January 24, 2012;
59(4):
379 - 387.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S.-C. Li, X.-W. Liao, L. Li, L.-M. Zhang, and Z.-Y. Xu
Prediction of significant coronary artery disease in patients undergoing operations for rheumatic mitral valve disease
Eur J Cardiothorac Surg,
January 1, 2012;
41(1):
82 - 86.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Dedic, T. S. S. Genders, B. S. Ferket, T. W. Galema, N. R. A. Mollet, A. Moelker, M. G. M. Hunink, P. J. de Feyter, and K. Nieman
Stable Angina Pectoris: Head-to-Head Comparison of Prognostic Value of Cardiac CT and Exercise Testing
Radiology,
November 1, 2011;
261(2):
428 - 436.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Korosoglou, G. Gitsioudis, A. Voss, S. Lehrke, N. Riedle, S. J. Buss, C. Zugck, E. Giannitsis, N. F. Osman, and H. A. Katus
Strain-Encoded Cardiac Magnetic Resonance During High-Dose Dobutamine Stress Testing for the Estimation of Cardiac Outcomes: Comparison to Clinical Parameters and Conventional Wall Motion Readings
J. Am. Coll. Cardiol.,
September 6, 2011;
58(11):
1140 - 1149.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Dorenkamp, K. Bonaventura, C. Sohns, C. R. Becker, and A. W. Leber
Direct costs and cost-effectiveness of dual-source computed tomography and invasive coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease
Heart,
August 16, 2011;
(2011)
heartjnl-2011-300149v1.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
E. Nicol, J. Stirrup, A. Kelion, and S. Padley
Diagnostic performance
OSH Cardiovascular Computed Tomography,
August 1, 2011;
1(1):
med-9780199572595-div1-01 - med-9780199572595-div1-01.
[Full Text]
|
|
|
|
|
|
|
T. S. S. Genders, E. W. Steyerberg, H. Alkadhi, S. Leschka, L. Desbiolles, K. Nieman, T. W. Galema, W. B. Meijboom, N. R. Mollet, P. J. de Feyter, et al.
A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension
Eur. Heart J.,
June 1, 2011;
32(11):
1316 - 1330.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Korosoglou, S. Lehrke, D. Mueller, W. Hosch, H.-U. Kauczor, P. M. Humpert, E. Giannitsis, and H. A. Katus
Determinants of troponin release in patients with stable coronary artery disease: insights from CT angiography characteristics of atherosclerotic plaque
Heart,
May 15, 2011;
97(10):
823 - 831.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Geleijns, R. M. S. Joemai, M. Dewey, A. de Roos, M. Zankl, A. C. Cantera, and M. S. Artells
Radiation Exposure to Patients in a Multicenter Coronary Angiography Trial (CORE 64)
Am. J. Roentgenol.,
May 1, 2011;
196(5):
1126 - 1132.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. C. Levin, L. Parker, E. J. Halpern, P. R. Julsrud, and V. M. Rao
The Lack of Growth in Use of Coronary CT Angiography: Is It Being Appropriately Used?
Am. J. Roentgenol.,
April 1, 2011;
196(4):
862 - 867.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. W. Kwon, Y. J. Kim, J. Shim, J. M. Sung, M. E. Han, D. W. Kang, J.-Y. Kim, B. W. Choi, and H.-J. Chang
Coronary Artery Calcium Scoring Does Not Add Prognostic Value to Standard 64-Section CT Angiography Protocol in Low-Risk Patients Suspected of Having Coronary Artery Disease
Radiology,
April 1, 2011;
259(1):
92 - 99.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Blaha, R. S. Blumenthal, M. J. Budoff, and K. Nasir
Understanding the Utility of Zero Coronary Calcium as a Prognostic Test: A Bayesian Approach
Circ Cardiovasc Qual Outcomes,
March 1, 2011;
4(2):
253 - 256.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Yerramasu, S. Venuraju, and A. Lahiri
Evolving role of cardiac CT in the diagnosis of coronary artery disease
Postgrad. Med. J.,
March 1, 2011;
87(1025):
180 - 188.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Schuijf, S. Achenbach, P. J. de Feyter, and J. J. Bax
Current applications and limitations of coronary computed tomography angiography in stable coronary artery disease
Heart,
February 15, 2011;
97(4):
330 - 337.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Catalan, R. Leta, A. Hidalgo, J. Montiel, X. Alomar, D. Vilades, A. Barros, S. Pujadas, F. Carreras, J. M. Padro, et al.
Ruling Out Coronary Artery Disease with Noninvasive Coronary Multidetector CT Angiography before Noncoronary Cardiovascular Surgery
Radiology,
February 1, 2011;
258(2):
426 - 434.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. van Velzen, J. D. Schuijf, L. J. Kroft, and J. J. Bax
Chapter 22 CT angiography and other applications of CT
The ESC Textbook of Acute and Intensive Cardiac Care,
December 1, 2010;
1(1):
med-9780199584314-chapter - med-9780199584314-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Korosoglou, Y. Elhmidi, H. Steen, D. Schellberg, N. Riedle, J. Ahrens, S. Lehrke, C. Merten, D. Lossnitzer, J. Radeleff, et al.
Prognostic Value of High-Dose Dobutamine Stress Magnetic Resonance Imaging in 1,493 Consecutive Patients: Assessment of Myocardial Wall Motion and Perfusion
J. Am. Coll. Cardiol.,
October 5, 2010;
56(15):
1225 - 1234.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. West and G. A. Beller
256- and 320-row coronary CTA: is more better?
Eur. Heart J.,
August 1, 2010;
31(15):
1823 - 1825.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Achenbach and W. G. Daniel
Cardiac imaging in the patient with chest pain: coronary CT angiography
Heart,
August 1, 2010;
96(15):
1241 - 1246.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Chua
The evolving role of molecular imaging for coronary artery disease: where do we stand today?
Heart Asia,
July 5, 2010;
1(1):
1 - 5.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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, J. M. Miller, 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
J. Am. Coll. Cardiol.,
June 8, 2010;
55(23):
2663 - 2699.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Achenbach and P. Raggi
Imaging of coronary atherosclerosis by computed tomography
Eur. Heart J.,
June 2, 2010;
31(12):
1442 - 1448.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Scheffel, P. Stolzmann, A. Plass, S. Leschka, J. Grunenfelder, V. Falk, B. Marincek, and H. Alkadhi
Coronary artery disease in patients with cardiac tumors: preoperative assessment by computed tomography coronary angiography
Interact CardioVasc Thorac Surg,
April 1, 2010;
10(4):
513 - 518.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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.
[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]
|
|
|
|
|
|
|
M. Dewey, E. Zimmermann, F. Deissenrieder, M. Laule, H.-P. Dubel, P. Schlattmann, F. Knebel, W. Rutsch, and B. Hamm
Noninvasive Coronary Angiography by 320-Row Computed Tomography With Lower Radiation Exposure and Maintained Diagnostic Accuracy: Comparison of Results With Cardiac Catheterization in a Head-to-Head Pilot Investigation
Circulation,
September 8, 2009;
120(10):
867 - 875.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. C. Weustink, N. R. Mollet, L. A. Neefjes, M. van Straten, E. Neoh, S. Kyrzopoulos, B. W. Meijboom, C. van Mieghem, F. Cademartiri, P. J. de Feyter, et al.
Preserved Diagnostic Performance of Dual-Source CT Coronary Angiography with Reduced Radiation Exposure and Cancer Risk1
Radiology,
July 1, 2009;
252(1):
53 - 60.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Pugliese, M. G. M. Hunink, K. Gruszczynska, F. Alberghina, R. Malago, N. van Pelt, N. R. Mollet, F. Cademartiri, A. C. Weustink, W. B. Meijboom, et al.
Learning Curve for Coronary CT Angiography: What Constitutes Sufficient Training?1
Radiology,
May 1, 2009;
251(2):
359 - 368.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Ramcharitar, F. Pugliese, C. Schultz, J. Ligthart, P. de Feyter, H. Li, N. Mollet, M. van de Ent, P. W. Serruys, and R. J. van Geuns
Integration of Multislice Computed Tomography With Magnetic Navigation Facilitates Percutaneous Coronary Interventions Without Additional Contrast Agents
J. Am. Coll. Cardiol.,
March 3, 2009;
53(9):
741 - 746.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Gibbons, P. A. Araoz, and E. E. Williamson
The Year in Cardiac Imaging
J. Am. Coll. Cardiol.,
January 6, 2009;
53(1):
54 - 70.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Schuijf, N. R. Van de Veire, E. E. van der Wall, and J. J. Bax
CHAPTER 3 Choice of Imaging Techniques
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[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]
|
|
|
|
|
|
|
P. Narayan, C. A. Rogers, I. Davies, G. D. Angelini, and A. J. Bryan
Type A aortic dissection: Has surgical outcome improved with time?
J. Thorac. Cardiovasc. Surg.,
November 1, 2008;
136(5):
1172 - 1177.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Gibbons
Noninvasive Diagnosis and Prognosis Assessment in Chronic Coronary Artery Disease: Stress Testing With and Without Imaging Perspective
Circ Cardiovasc Imaging,
November 1, 2008;
1(3):
257 - 269.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Pundziute, J. D. Schuijf, J. W. Jukema, I. Decramer, G. Sarno, P. K. Vanhoenacker, E. Boersma, J. H.C. Reiber, M. J. Schalij, W. Wijns, et al.
Evaluation of plaque characteristics in acute coronary syndromes: non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis
Eur. Heart J.,
October 1, 2008;
29(19):
2373 - 2381.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A.-C. Pouleur, J.-B. le Polain de Waroux, J. Kefer, A. Pasquet, J.-L. Vanoverschelde, and B. L. Gerber
Direct Comparison of Whole-Heart Navigator-Gated Magnetic Resonance Coronary Angiography and 40- and 64-Slice Multidetector Row Computed Tomography to Detect the Coronary Artery Stenosis in Patients Scheduled for Conventional Coronary Angiography
Circ Cardiovasc Imaging,
September 1, 2008;
1(2):
114 - 121.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H Scheffel, H Alkadhi, S Leschka, A Plass, L Desbiolles, I Guber, T Krauss, J Gruenenfelder, M Genoni, T F Luescher, et al.
Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance
Heart,
September 1, 2008;
94(9):
1132 - 1137.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. A. Bluemke, S. Achenbach, M. Budoff, T. C. Gerber, B. Gersh, L. D. Hillis, W. G. Hundley, W. J. Manning, B. F. Printz, M. Stuber, et al.
Noninvasive Coronary Artery Imaging: Magnetic Resonance Angiography and Multidetector Computed Tomography Angiography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention, and the Councils on Clinical Cardiology and Cardiovascular Disease in the Young
Circulation,
July 29, 2008;
118(5):
586 - 606.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Sanz, P. R. Moreno, and V. Fuster
The Year in Atherothrombosis
J. Am. Coll. Cardiol.,
March 4, 2008;
51(9):
944 - 955.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Stangl, V. Witzel, G. Baumann, and K. Stangl
Current diagnostic concepts to detect coronary artery disease in women
Eur. Heart J.,
March 2, 2008;
29(6):
707 - 717.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al.
Highlights of the Year in JACC 2007
J. Am. Coll. Cardiol.,
January 29, 2008;
51(4):
490 - 512.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. M. Bateman
Business aspects of cardiovascular computed tomography: tackling the challenges.
J. Am. Coll. Cardiol. Img.,
January 1, 2008;
1(1):
111 - 118.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
