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Published on: August 28, 2018
Diagnostic accuracy of computed tomography coronary angiography in a high risk symptomatic population
Erica Maffei1, Alessandro Palumbo, Chiara Martini
1Department of Radiology and Cardiology, University Hospital of Parma,Parma, Italy.
Insights
64-slice CT coronary angiography (CT-CA) accurately detects significant coronary artery stenosis in high-risk patients with chest pain. This imaging technique offers a reliable alternative to invasive coronary angiography (ICA) for diagnosing coronary artery disease.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
- Accurate and timely diagnosis of significant coronary artery stenosis is crucial for effective patient management.
- Chest pain is a common symptom prompting cardiac evaluation, necessitating reliable diagnostic tools.
Purpose of the Study:
- To assess the diagnostic accuracy of 64-slice computed tomography coronary angiography (CT-CA).
- To compare CT-CA with invasive coronary angiography (ICA) for detecting significant coronary artery stenosis (>= 50% lumen reduction).
- To evaluate CT-CA in a specific patient cohort presenting with chest pain and high cardiovascular risk.
Main Methods:
- Prospective enrollment of 44 patients with chest pain.
- Administration of beta-blockers for heart rates >= 70 bpm.
- Intravenous contrast injection for CT-CA acquisition with an average scan time of 13.3 seconds.
- Comparison of CT-CA findings against ICA as the gold standard by two independent observers.
Main Results:
- ICA revealed no CAD in 13.6%, non-significant CAD in 4.6%, single-vessel disease in 27.2%, and multi-vessel disease in 54.6% of patients.
- CT-CA demonstrated high diagnostic performance: sensitivity 98.6%, specificity 92.4%, positive predictive value 89.7%, and negative predictive value 99%.
- All patients with significant coronary lesions were correctly identified by CT-CA.
Conclusions:
- 64-slice CT coronary angiography (CT-CA) is a highly accurate imaging modality.
- CT-CA serves as a dependable alternative to invasive coronary angiography (ICA) for selected patients.
- This non-invasive approach aids in the diagnosis of coronary artery stenosis in patients with chest pain and high risk.
Objective:
To evaluate the diagnostic accuracy of 64-slice computed tomography (CT) coronary angiography (CA) for the detection of significant coronary artery stenosis (> or = 50% lumen reduction) as compared to invasive coronary angiography (ICA) in a population of patients with chest pain and high risk.
Materials And Methods:
44 patients (30 male; mean age 60.2+/- 12.1 yrs) with chest pain were prospectively enrolled. In patients with heart rate > or = 70 bpm an oral dose of 100 mg of beta-blocker was administered. For CT-CA (Sensation 64, Siemens, Germany) an intravenous bolus of 100 ml of iodinated contrast material (Iomeron 400, Bracco, Italy) was injected. The average scan time was 13.3 +/- 0.9s. Two observers evaluated CT-CA vs. ICA as a reference standard for the detection of significant (> or = 50% lumen reduction) coronary artery stenosis.
Results:
ICA demonstrated the absence of coronary artery disease (CAD) in 13.6% of the patients (6/44), the presence of non significant CAD 4.6% (2/44), single vessel disease in 27.2% (12/44) and multi-vessel disease in 54.6% (24/44) of the patients. None of the patients was excluded from the study population. Ninety-three significant obstructive coronary lesions were observed. Sensitivity, specificity, positive and negative predictive value of CT-CA were 98.6% (70/71), 92.4% (97/105), 89.7% (70/78) and 99% (97/98), respectively. All patients with at least one significant coronary lesion were correctly identified by CT-CA.
Conclusions:
CT-CA is a reliable alternative to ICA in a selected population of patients with chest pain and high risk.
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