Key result
Exercise bicycle testing had significantly lower sensitivity (76% vs 100%) and specificity (47% vs 74%) compared to 64-slice CTCA for detecting obstructive coronary artery disease.
Why the study?
Does 64-slice CTCA improve diagnostic performance compared to exercise bicycle testing and SPECT for detecting obstructive CAD in patients with stable angina?
Cross-Sectional (n=376)
Blinded interpretation of diagnostic tests
No
Does 64-slice CTCA improve diagnostic performance compared to exercise bicycle testing and SPECT for detecting obstructive CAD in patients with stable angina?
CTCA and SPECT provide superior diagnostic performance compared to traditional exercise bicycle testing for detecting obstructive CAD in patients with stable angina.
Answers are grounded in this paper and cite their sources.
Exercise testing underperforms CTCA diagnostically; leaves open its role in CAD evaluation pending larger studies.
To conduct a comparison of the diagnostic performance of exercise bicycle testing and single-photon emission computed tomography (SPECT) with computed tomography coronary angiography (CTCA) for the detection of obstructive coronary artery disease (CAD) in patients with stable angina. 376 symptomatic patients (254 men, 122 women, mean age 60.4 ± 10.0 years) referred for noninvasive stress testing (exercise bicycle test and/or SPECT) and invasive coronary angiography were included. All patients underwent additional 64-slice CTCA. The diagnostic performance of exercise bicycle testing (ST segment depression), SPECT (reversible perfusion defect) and CTCA (≥50% lumen diameter reduction) was presented as sensitivity, specificity, positive and negative predictive value (PPV and NPV) to detect or rule out obstructive CAD with quantitative coronary angiography as reference standard. Comparisons of exercise bicycle testing versus CTCA (n = 334), and SPECT versus CTCA (n = 61) were performed. The diagnostic performance of exercise bicycle testing was significantly (P value < 0.001) lower compared to CTCA: sensitivity of 76% (95% CI, 71-82) vs. 100% (95% CI, 97-100); specificity of 47% (95% CI, 36-58) vs. 74% (95% CI, 63-82). We observed a PPV of 70% (95% CI, 65-75) vs. 91% (95% CI, 87-94); and NPV of 30% (95%, 25-35) vs. 99% (95%, 90-100). There was a statistically significant difference in sensitivity (P value < 0.05) between SPECT and CTCA: 89% (95% CI, 75-96) vs. 98% (95% CI, 87-100); but not in specificity (P value > 0.05): 77% (95% CI, 50-92) vs. 82% (95% CI, 56-95). We observed a PPV of 91% (95% CI, 77-97) vs. 93% (95% CI, 81-98); and NPV of 72% (95%, 46-89) vs. 93% (95%, 66-100). SPECT and CTCA yielded higher diagnostic performance compared to traditional exercise bicycle testing for the detection and rule out of obstructive CAD in patients with stable angina.
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Weustink et al. (2011) conducted a cross-sectional in Stable angina / suspected obstructive coronary artery disease (n=376). Exercise bicycle testing vs. 64-slice computed tomography coronary angiography (CTCA) was evaluated on Sensitivity for detecting obstructive coronary artery disease (p=<0.001). Exercise bicycle testing had significantly lower sensitivity (76% vs 100%) and specificity (47% vs 74%) compared to 64-slice CTCA for detecting obstructive coronary artery disease.
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