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Updated: Apr 17, 2026
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Detection of significant coronary artery disease by noninvasive anatomical and functional imaging
Danilo Neglia1, Daniele Rovai1, Chiara Caselli1
1From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology, Warsaw, Poland (A.T.); Department of Nuclear Medicine, University Hospital Val d'Hebron, Institut Catala de la Salut, Barcelona, Spain (S.A.-B., M.N.P.); Department of Cardiology, Alb-Fils-Kliniken, Göppingen, Germany (S.S., T.D.); Emergency Department, Cardiology, Ospedale della Versilia, Lido di Camaiore, Italy (R.P., G.C.); Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece (C.A.); Centre for Advanced Cardiovascular Imaging, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom (C.A., F.P.); Department of Nuclear Medicine, Bichat University Hospital, Département Hospitalo-Universitaire FIRE, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France (F.R., D.L.G.); Cardiothoracic and Vascular Department, Azienda Ospedaliera Universitaria Careggi (F.C., S.V., G.G.) and Don Carlo Gnocchi Foundation, IRCCS (G.F.G.), Florence, Italy; Department of Health Science and Internal Medicine, IRCCS Hospital San Martino, National Institute for Cancer Research and University of Genoa, Genoa, Italy (C.Z., S.C., G.S.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (F.Marsico, P.P.F.); Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain (C.F.-G., L.M.R., J.L.Z.
Background:
The choice of imaging techniques in patients with suspected coronary artery disease (CAD) varies between countries, regions, and hospitals. This prospective, multicenter, comparative effectiveness study was designed to assess the relative accuracy of commonly used imaging techniques for identifying patients with significant CAD.
Methods And Results:
A total of 475 patients with stable chest pain and intermediate likelihood of CAD underwent coronary computed tomographic angiography and stress myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography, and ventricular wall motion imaging by stress echocardiography or cardiac magnetic resonance. If ≥1 test was abnormal, patients underwent invasive coronary angiography. Significant CAD was defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70% stenosis with fractional flow reserve ≤0.8. Significant CAD was present in 29% of patients. In a patient-based analysis, coronary computed tomographic angiography had the highest diagnostic accuracy, the area under the receiver operating characteristics curve being 0.91 (95% confidence interval, 0.88-0.94), sensitivity being 91%, and specificity being 92%. Myocardial perfusion imaging had good diagnostic accuracy (area under the curve, 0.74; confidence interval, 0.69-0.78), sensitivity 74%, and specificity 73%. Wall motion imaging had similar accuracy (area under the curve, 0.70; confidence interval, 0.65-0.75) but lower sensitivity (49%, P<0.001) and higher specificity (92%, P<0.001). The diagnostic accuracy of myocardial perfusion imaging and wall motion imaging were lower than that of coronary computed tomographic angiography (P<0.001).
Conclusions:
In a multicenter European population of patients with stable chest pain and low prevalence of CAD, coronary computed tomographic angiography is more accurate than noninvasive functional testing for detecting significant CAD defined invasively.
Clinical Trial Registration Url:
http://www.clinicaltrials.gov. Unique identifier: NCT00979199.
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