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Positive predictive value of computed tomography coronary angiography in clinical practice

Jan G J Groothuis1, Aernout M Beek, Martijn R Meijerink

  • 1Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands. j.groothuis@vumc.nl

International Journal of Cardiology
|January 4, 2011
PubMed

Insights

Computed tomography coronary angiography (CTCA) has a lower positive predictive value (PPV) for detecting coronary artery disease (CAD) in routine clinical practice than previously reported. This finding is crucial for accurate diagnosis in patients presenting with chest pain.

Area of Science:

  • Cardiovascular Imaging
  • Diagnostic Accuracy
  • Medical Technology Assessment

Background:

  • Computed tomography coronary angiography (CTCA) is increasingly used for diagnosing coronary artery disease (CAD).
  • Previous studies on CTCA diagnostic performance focused on highly selected patient groups with high CAD prevalence.
  • The positive predictive value (PPV) of CTCA in real-world clinical settings remains uncertain.

Purpose of the Study:

  • To determine the PPV of CTCA for detecting significant CAD in patients undergoing non-invasive evaluation for chest pain.
  • To assess CTCA accuracy in a low to intermediate pre-test probability population in clinical practice.

Main Methods:

  • 181 patients with low-to-intermediate pre-test probability CAD underwent 64-slice CTCA.
  • CTCA findings were categorized as normal, non-obstructive, or obstructive CAD (>50% diameter stenosis).
  • Patients with obstructive CAD on CTCA proceeded to invasive coronary angiography (ICA) for confirmation.

Main Results:

  • CTCA identified obstructive CAD in 35.9% of patients (65/181).
  • Significant CAD (>50% stenosis on ICA) was confirmed in 14.4% of patients (26/181).
  • The PPV of CTCA for significant CAD was 40.0% per patient, 31.3% per vessel, and 25.5% per segment.

Conclusions:

  • The PPV of CTCA for significant CAD is substantially lower in clinically referred patients with low-to-intermediate pre-test probability CAD.
  • These findings suggest a need for careful interpretation of CTCA results in this population.
  • The study highlights the importance of evaluating diagnostic test performance in diverse clinical settings.
Abstract

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