Accuracy of coronary artery stenosis detection with CT versus conventional coronary angiography compared with composite findings from both tests as an enhanced reference standard

ObjectiveTo prospectively compare the accuracy of coronary CT angiography (CCTA) and conventional coronary angiography (CCA) for stenosis detection using composite findings from both tests as an enhanced reference standard.MethodsOne hundred thirteen patients underwent CCTA and CCA. Per-segment and per-patient accuracy of CCTA compared with initial CCA interpretation were determined. Angiographers were then unblinded to the CCTA results and re-evaluation of the CCA studies was performed with knowledge of CCTA findings, which was used as an enhanced reference standard to compare the diagnostic accuracy of CCTA versus CCA.ResultsWhen using the enhanced reference standard instead of initial CCA interpretation, CCTA accuracy for identifying segments (patients) with ≥50% stenosis increased from 97.7% (96.5%) to 98.1% (98.2%), sensitivity from 90.5% (100%) to 90.8% (100%), and specificity from 98.4% (94.3%) to 98.9% (97.1%). CCTA identified six segments and two patients with stenoses ≥50% missed on initial CCA interpretation. Compared with the enhanced reference standard the accuracies of CCTA and of initial CCA interpretation were not different (p = 0.87).ConclusionCCTA compares favourably with CCA for stenosis detection. Use of a composite reference standard combining findings from both tests can control for the effect of false-negative CCA results when evaluating the accuracy of CCTA.

[1]  R. Dinsmore,et al.  Interobserver Variability in Coronary Angiography , 1976, Circulation.

[2]  C. Herzog,et al.  Coronary CT angiography. , 2007, Radiology.

[3]  L. Husmann,et al.  Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating. , 2009, European heart journal.

[4]  T. Seyfarth,et al.  Diagnostic value of 64-slice multi-detector row cardiac CTA in symptomatic patients , 2007, European Radiology.

[5]  J. Spertus,et al.  ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Th , 2009, Journal of the American College of Cardiology.

[6]  Borut Marincek,et al.  Dual-source computed tomography coronary angiography: influence of obesity, calcium load, and heart rate on diagnostic accuracy. , 2008, European heart journal.

[7]  Massimo Midiri,et al.  Italian multicenter, prospective study to evaluate the negative predictive value of 16- and 64-slice MDCT imaging in patients scheduled for coronary angiography (NIMISCAD-Non Invasive Multicenter Italian Study for Coronary Artery Disease) , 2009, European Radiology.

[8]  Werner Bautz,et al.  Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography. , 2007, Journal of the American College of Cardiology.

[9]  Mario J. Garcia,et al.  ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization , 2009, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[10]  A. Bowker,et al.  A test for symmetry in contingency tables. , 1948, Journal of the American Statistical Association.

[11]  J. Saurin,et al.  [Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults]. , 2004, Gastroenterologie clinique et biologique.

[12]  Frederick A. Masoudi,et al.  ACCF/SCAI/STS/MTS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization. Commentary , 2009 .

[13]  L. Zir,et al.  Editorial note Observer variability in coronary angiography , 1983 .

[14]  Gabriel P. Krestin,et al.  Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris , 2006, European Radiology.

[15]  N. Paul,et al.  Perioperative β-Blockers : Use With Caution Perioperative β Blockers in Patients Having Non-Cardiac Surgery : A Meta-Analysis , 2010 .

[16]  Paul D Stein,et al.  64-slice CT for diagnosis of coronary artery disease: a systematic review. , 2008, The American journal of medicine.

[17]  M. Budoff,et al.  Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Indi , 2008, Journal of the American College of Cardiology.

[18]  H De Geest,et al.  Intravascular ultrasound versus angiography for measurement of luminal diameters in normal and diseased coronary arteries. , 1994, American heart journal.

[19]  C M Grondin,et al.  Discrepancies Between Cineangiographic and Postmortem Findings in Patients with Coronary Artery Disease and Recent Myocardial Revascularization , 1974, Circulation.

[20]  W. Frishman,et al.  Noninvasive Coronary Angiography With Multislice Computed Tomography , 2006 .

[21]  Konstantin Nikolaou,et al.  Diagnostic Accuracy of Dual-Source Computed Tomography in the Diagnosis of Coronary Artery Disease , 2007, Investigative radiology.

[22]  G. Diamond,et al.  Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. , 1979, The New England journal of medicine.

[23]  E. Topol,et al.  Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. , 1995, Circulation.

[24]  Konstantin Nikolaou,et al.  Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. , 2006, Journal of the American College of Cardiology.

[25]  H. Alkadhi,et al.  Comparison of diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low, intermediate, and high cardiovascular risk. , 2008, Academic radiology.

[26]  M. Reiser,et al.  Detection of Coronary Artery Stenoses With Multislice Helical CT Angiography , 2002, Journal of computer assisted tomography.

[27]  W. Howard,et al.  Optimal Medical Therapy with or without PCI for Stable Coronary Disease , 2008 .

[28]  Pedro A. Lemos,et al.  Reliable Noninvasive Coronary Angiography With Fast Submillimeter Multislice Spiral Computed Tomography , 2002, Circulation.

[29]  K. Stierstorfer,et al.  First performance evaluation of a dual-source CT (DSCT) system , 2006, European Radiology.

[30]  G. Hillis,et al.  64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis , 2008, Heart.

[31]  F. Sones Cine-cardio-angiography. , 1958, Pediatric clinics of North America.