Diagnostic Performance of Coronary Angiography by 64-Row CT
Julie M. Miller, M.D., Carlos E. Rochitte, M.D., Marc Dewey, M.D., Armin Arbab-Zadeh, M.D., Hiroyuki Niinuma, M.D., Ph.D., Ilan Gottlieb, M.D., Narinder Paul, M.D., Melvin E. Clouse, M.D., Edward P. Shapiro, M.D., John Hoe, M.D., Albert C. Lardo, Ph.D., David E. Bush, M.D., Albert de Roos, M.D., Christopher Cox, Ph.D., Jeffery Brinker, M.D., and João A.C. Lima, M.D.
Background The accuracy of multidetector computed tomographic(CT) angiography involving 64 detectors has not been well established.
Methods We conducted a multicenter study to examine the accuracyof 64-row, 0.5-mm multidetector CT angiography as compared withconventional coronary angiography in patients with suspectedcoronary artery disease. Nine centers enrolled patients whounderwent calcium scoring and multidetector CT angiography beforeconventional coronary angiography. In 291 patients with calciumscores of 600 or less, segments 1.5 mm or more in diameter wereanalyzed by means of CT and conventional angiography at independentcore laboratories. Stenoses of 50% or more were considered obstructive.The area under the receiver-operating-characteristic curve (AUC)was used to evaluate diagnostic accuracy relative to that ofconventional angiography and subsequent revascularization status,whereas disease severity was assessed with the use of the modifiedDuke Coronary Artery Disease Index.
Results A total of 56% of patients had obstructive coronaryartery disease. The patient-based diagnostic accuracy of quantitativeCT angiography for detecting or ruling out stenoses of 50% ormore according to conventional angiography revealed an AUC of0.93 (95% confidence interval [CI], 0.90 to 0.96), with a sensitivityof 85% (95% CI, 79 to 90), a specificity of 90% (95% CI, 83to 94), a positive predictive value of 91% (95% CI, 86 to 95),and a negative predictive value of 83% (95% CI, 75 to 89). CTangiography was similar to conventional angiography in its abilityto identify patients who subsequently underwent revascularization:the AUC was 0.84 (95% CI, 0.79 to 0.88) for multidetector CTangiography and 0.82 (95% CI, 0.77 to 0.86) for conventionalangiography. A per-vessel analysis of 866 vessels yielded anAUC of 0.91 (95% CI, 0.88 to 0.93). Disease severity ascertainedby CT and conventional angiography was well correlated (r=0.81;95% CI, 0.76 to 0.84). Two patients had important reactionsto contrast medium after CT angiography.
Conclusions Multidetector CT angiography accurately identifiesthe presence and severity of obstructive coronary artery diseaseand subsequent revascularization in symptomatic patients. Thenegative and positive predictive values indicate that multidetectorCT angiography cannot replace conventional coronary angiographyat present. (ClinicalTrials.gov number, NCT00738218
[ClinicalTrials.gov]
.)
Source Information
From Johns Hopkins University School of Medicine (J.M.M., A.A.-Z., I.G., E.P.S., A.C.L., D.E.B., J.B., J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (C.C.) — both in Baltimore; University of São Paulo, InCor São Paulo Heart Institute, São Paulo (C.E.R.); Charité Medical School, Humboldt–Universität zu Berlin and Freie Universität zu Berlin, Berlin (M.D.); Iwate Medical University, Morioka, Japan (H.N.); Toronto General Hospital, Toronto (N.P.); Beth Israel Deaconess Medical Center, Harvard University, Boston (M.E.C.); Mount Elizabeth Hospital, Singapore, Singapore (J.H.); and Leiden University Medical Center, Leiden, the Netherlands (A.R.).
Address reprint requests to Dr. Lima at the Johns Hopkins Hospital, 600 N. Wolfe St., Blalock 524, Baltimore, MD 21287, or at jlima{at}jhmi.edu.
Coronary Angiography by 64-Row CT
McCulloch A. C., Paulin S., Gerard S. K., Karthikeyan G., Vorobiof G., Fogarty W. M. Jr., Lima J. A.C., Miller J. M., the CORE 64 Investigators , Walsh J., Redberg R. F.
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N Engl J Med 2009;
360:2027-2031, May 7, 2009.
Correspondence
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