Author + information
- Received May 28, 2008
- Revision received August 21, 2008
- Accepted August 27, 2008
- Published online December 16, 2008.
- W. Bob Meijboom, MD⁎,†,
- Matthijs F.L. Meijs, MD§∥,
- Joanne D. Schuijf, MD, PhD¶,#,
- Maarten J. Cramer, MD, PhD§,
- Nico R. Mollet, MD, PhD⁎,†,
- Carlos A.G. van Mieghem, MD⁎,†,
- Koen Nieman, MD, PhD⁎,†,
- Jacob M. van Werkhoven, MD∥,#,
- Gabija Pundziute, MD∥,#,
- Annick C. Weustink, MD⁎,†,
- Alexander M. de Vos, MD§∥,
- Francesca Pugliese, MD⁎,†,
- Benno Rensing, MD, PhD⁎⁎,
- J. Wouter Jukema, MD, PhD¶,
- Jeroen J. Bax, MD, PhD¶,
- Mathias Prokop, MD, PhD∥,
- Pieter A. Doevendans, MD, PhD§,
- Myriam G.M. Hunink, MD, PhD†,‡,
- Gabriel P. Krestin, MD, PhD† and
- Pim J. de Feyter, MD, PhD⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Pim J. de Feyter, Erasmus Medical Center, Department of Cardiology and Radiology, Room Hs 227, Gravendijkwal 230, P.O. Box 2040, 3015 GD Rotterdam, the Netherlands
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 ≥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.
Dr. Prokop is on the Medical Advisory Board of Philips Medical Systems. This study was funded by investigational grant number 945-04-263 from the Zon/MW, a Dutch governmental organization. The Zon/MW had no involvement in the design or conduct of this study, data management and analysis, or manuscript preparation and review or authorization for submission. Drs. Meijboom and Meijs contributed equally to this article. Steven E. Nissen, MD, MACC, served as Guest Editor for this article.
- Received May 28, 2008.
- Revision received August 21, 2008.
- Accepted August 27, 2008.
- American College of Cardiology Foundation