Author + information
- Received May 13, 2008
- Revision received July 11, 2008
- Accepted July 30, 2008
- Published online November 18, 2008.
- Matthew J. Budoff, MD⁎,⁎ (, )
- David Dowe, MD†,
- James G. Jollis, MD‡,
- Michael Gitter, MD§,
- John Sutherland, MD∥,
- Edward Halamert, MD¶,
- Markus Scherer, MD#,
- Raye Bellinger, MD⁎⁎,
- Arthur Martin, MD††,
- Robert Benton, MD‡‡,
- Augustin Delago, MD‡‡ and
- James K. Min, MD§§
- ↵⁎Reprint requests and correspondence:
Dr. Matthew J. Budoff, Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, 1124 West Carson Street, Torrance, California
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 ≥50% 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 ≤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)
Supported by General Electric (GE); GE Healthcare sponsored and coordinated the study and provided recommendations for computed tomography X-ray dosing and injection protocols, site training, and logistical support for data transfer from individual sites to the core laboratories; GE Healthcare allowed the principal investigators to direct the data analysis, manuscript preparation, and review or authorization for submission. Drs. Budoff and Min are on the Speakers' Bureau for General Electric.
- Received May 13, 2008.
- Revision received July 11, 2008.
- Accepted July 30, 2008.
- American College of Cardiology Foundation