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Diagnostic performance of computed tomography coronary angiography to detect and exclude left main and/or

Anoeshka S Dharampal1, Stella L Papadopoulou, Alexia Rossi

  • 1Department of Radiology, Erasmus MC, Room Ca207a, s-Gravendijkwal 230, PO Box 2040, 3015 CE, Rotterdam, The Netherlands, a.dharampal@erasmusmc.nl.

European Radiology
|July 2, 2013
PubMed

Insights

Computed tomography coronary angiography (CTCA) accurately excludes high-risk coronary artery disease in symptomatic patients. However, CTCA overestimates disease in 47% of cases, impacting detection accuracy.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Performance Evaluation

Background:

  • Coronary artery disease (CAD) diagnosis relies on accurate risk stratification.
  • Left main (LM) and/or three-vessel CAD represents high-risk disease.
  • CT coronary angiography (CTCA) is a non-invasive imaging modality for CAD assessment.

Purpose of the Study:

  • To evaluate the diagnostic performance of CTCA in detecting and excluding high-risk CAD (LM and/or three-vessel disease).
  • To compare the discriminatory value of CTCA against the Duke risk score and calcium score for high-risk CAD.

Main Methods:

  • A prospective study included 1,159 symptomatic patients without prior revascularization undergoing both invasive coronary angiography (ICA) and CTCA.
  • High-risk CAD was defined as LM and/or three-vessel obstructive CAD (≥50% diameter stenosis).
  • Diagnostic performance metrics (sensitivity, specificity, PPV, NPV) and likelihood ratios for CTCA were calculated.

Main Results:

  • High-risk CAD was present in 17% of patients based on ICA.
  • CTCA demonstrated a sensitivity of 95% and specificity of 83% for high-risk CAD.
  • CTCA showed a negative predictive value of 99%, accurately excluding high-risk CAD, but had a positive predictive value of 53% due to 47% overestimation.

Conclusions:

  • CTCA is effective in accurately excluding high-risk coronary artery disease in symptomatic individuals.
  • The detection of high-risk CAD by CTCA is suboptimal due to significant overestimation.
  • CTCA offers incremental value in discriminating high-risk CAD compared to clinical risk scores and calcium scores.
Abstract

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