Key result
64-slice CTCA detects significant CAD with ~99% sensitivity and high negative predictive value.
Why the study?
The diagnostic accuracy of 64-slice computed tomographic coronary angiography to detect or rule out significant coronary artery disease was not fully established.
Does 64-slice computed tomographic coronary angiography (CTCA) accurately detect or rule out significant coronary artery disease compared to conventional coronary angiography in symptomatic patients?
Observational (n=360)
Yes
Does 64-slice computed tomographic coronary angiography (CTCA) accurately detect or rule out significant coronary artery disease compared to conventional coronary angiography in symptomatic patients?
Effect estimate: Sensitivity 99% (95% CI 98-100)
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“When applied routinely in symptomatic patients at risk of coronary disease, in more than 50% of subjects, CT angiography 'detected' coronary obstructions that simply were not there”
“The population they studied was the wrong population, in the sense that that's how you validate the test, but that's not the group we are ultimately going to apply it in. We're not going to apply it in a group that has such a high prevalence of disease. It's going to be used when the prevalence is 15% to 20%. With a noninvasive test, it's going to be a little more sensitive, or a little more specific, and I think CT angiography is veering on the sensitive side to allow us to use it as a screening test.”
“I agree with his conclusion that indiscriminate use of CTA should be prevented”
64-slice CTCA is a highly sensitive noninvasive test reliable for ruling out significant coronary artery disease in symptomatic patients, though positive results often require confirmatory testing due to lower specificity.
OBJECTIVES: This study sought to determine the diagnostic accuracy of 64-slice computed tomographic coronary angiography (CTCA) to detect or rule out significant coronary artery disease (CAD). BACKGROUND: CTCA is emerging as a noninvasive technique to detect coronary atherosclerosis. METHODS: We conducted a prospective, multicenter, multivendor study involving 360 symptomatic patients with acute and stable anginal syndromes who were between 50 and 70 years of age and were referred for diagnostic conventional coronary angiography (CCA) from September 2004 through June 2006. All patients underwent a nonenhanced calcium scan and a CTCA, which was compared with CCA. No patients or segments were excluded because of impaired image quality attributable to either coronary motion or calcifications. Patient-, vessel-, and segment-based sensitivities and specificities were calculated to detect or rule out significant CAD, defined as >or=50% lumen diameter reduction. RESULTS: The prevalence among patients of having at least 1 significant stenosis was 68%. In a patient-based analysis, the sensitivity for detecting patients with significant CAD was 99% (95% confidence interval [CI]: 98% to 100%), specificity was 64% (95% CI: 55% to 73%), positive predictive value was 86% (95% CI: 82% to 90%), and negative predictive value was 97% (95% CI: 94% to 100%). In a segment-based analysis, the sensitivity was 88% (95% CI: 85% to 91%), specificity was 90% (95% CI: 89% to 92%), positive predictive value was 47% (95% CI: 44% to 51%), and negative predictive value was 99% (95% CI: 98% to 99%). CONCLUSIONS: Among patients in whom a decision had already been made to obtain CCA, 64-slice CTCA was reliable for ruling out significant CAD in patients with stable and unstable anginal syndromes. A positive 64-slice CTCA scan often overestimates the severity of atherosclerotic obstructions and requires further testing to guide patient management.
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Meijboom et al. (2008) conducted an observational in Acute and stable anginal syndromes (n=360). 64-slice computed tomographic coronary angiography (CTCA) vs. Conventional coronary angiography (CCA) was evaluated on Detecting patients with significant coronary artery disease (≥50% lumen diameter reduction) in a patient-based analysis (Sensitivity 99%, 95% CI 98-100). 64-slice CTCA demonstrated high diagnostic accuracy for detecting significant CAD, with a patient-based sensitivity of 99% (95% CI 98-100%) and negative predictive value of 97%.
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