Key result
In patients with chest pain without known CAD, 64-multidetector row CCTA demonstrated 95% sensitivity, 83% specificity, and 99% negative predictive value for detecting ≥50% coronary stenosis.
Why the study?
Does 64-multidetector row CCTA accurately detect obstructive coronary artery stenosis compared to invasive coronary angiography in patients with chest pain without known CAD?
Cross-Sectional (n=230)
Blinded readers
Yes
Does 64-multidetector row CCTA accurately detect obstructive coronary artery stenosis compared to invasive coronary angiography in patients with chest pain without known CAD?
Answers are grounded in this paper and cite their sources.
64-slice CCTA has high sensitivity and a 99% negative predictive value for detecting obstructive coronary stenosis, making it an effective noninvasive alternative to rule out CAD in patients with chest pain.
OBJECTIVES: The purpose of this study was to evaluate the diagnostic accuracy of electrocardiographically gated 64-multidetector row coronary computed tomographic angiography (CCTA) in individuals without known coronary artery disease (CAD). BACKGROUND: CCTA is a promising method for detection and exclusion of obstructive coronary artery stenosis. To date, no prospective multicenter trial has evaluated the diagnostic accuracy of 64-multidetector row CCTA in populations with intermediate prevalence of CAD. METHODS: We prospectively evaluated subjects with chest pain at 16 sites who were clinically referred for invasive coronary angiography (ICA). CCTAs were scored by consensus of 3 independent blinded readers. The ICAs were evaluated for coronary stenosis based on quantitative coronary angiography (QCA). No subjects were excluded for baseline coronary artery calcium score or body mass index. RESULTS: A total of 230 subjects underwent both CCTA and ICA (59.1% male; mean age: 57 +/- 10 years). On a patient-based model, the sensitivity, specificity, and positive and negative predictive values to detect > or =50% or > or =70% stenosis were 95%, 83%, 64%, and 99%, respectively, and 94%, 83%, 48%, 99%, respectively. No differences in sensitivity and specificity were noted for nonobese compared with obese subjects or for heart rates < or =65 beats/min compared with >65 beats/min, whereas calcium scores >400 reduced specificity significantly. CONCLUSIONS: In this prospective multicenter trial of chest pain patients without known CAD, 64-multidetector row CCTA possesses high diagnostic accuracy for detection of obstructive coronary stenosis at both thresholds of 50% and 70% stenosis. Importantly, the 99% negative predictive value at the patient and vessel level establishes CCTA as an effective noninvasive alternative to ICA to rule out obstructive coronary artery stenosis. (A Study of Computed Tomography [CT] for Evaluation of Coronary Artery Blockages in Typical or Atypical Chest Pain; NCT00348569).
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Budoff et al. (2008) conducted a cross-sectional in Chest pain without known coronary artery disease (n=230). 64-multidetector row coronary computed tomographic angiography (CCTA) vs. Invasive coronary angiography (ICA) was evaluated on Detection of ≥50% or ≥70% coronary artery stenosis (Sensitivity 95%, specificity 83%, PPV 64%, NPV 99% for ≥50% stenosis). In patients with chest pain without known CAD, 64-multidetector row CCTA demonstrated 95% sensitivity, 83% specificity, and 99% negative predictive value for detecting ≥50% coronary stenosis.
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