Coronary computed tomography angiography versus functional testing in a multi-ethnic urban county population

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Coronary artery disease (CAD) diagnosis relies on various imaging modalities.
• Coronary computed tomography angiography (CCTA) offers high positive predictive value.
• Optimizing diagnostic resource allocation is crucial in healthcare.

Purpose of the Study:

• To compare the diagnostic performance of CCTA against functional tests (MPI and ETT).
• To evaluate CCTA's effectiveness in a multi-ethnic urban population.
• To assess the positive predictive value of CCTA for obstructive CAD.

Main Methods:

• Retrospective observational study at Harbor-UCLA Medical Center.
• Inclusion of patients referred for invasive coronary angiography (ICA) after positive CCTA, MPI, or ETT (2012-2022).
• Analysis of ICA results to determine revascularization indications.

Main Results:

• CCTA demonstrated a significantly higher positive predictive value for revascularization indication compared to MPI and ETT.
• In a multi-ethnic urban cohort, 73% of CCTA-positive patients required revascularization versus 42% for MPI and 39% for ETT.
• CCTA showed significantly higher odds of correctly predicting revascularization indication (OR 6.34 vs. MPI, OR 5.97 vs. ETT).

Conclusions:

• CCTA exhibits superior positive predictive value for diagnosing obstructive CAD in multi-ethnic urban settings.
• Findings suggest CCTA can guide more effective allocation of diagnostic resources.
• CCTA performance supports its role in streamlining CAD diagnosis in public urban hospitals.