CT angiography highly accurate in detecting coronary artery disease
29 November 2007
Computed tomography (CT) angiography is as accurate as
an invasive angiogram in detecting coronary artery disease, according to the
findings of the first two prospective metacentre 64-slice scanner trials
presented at the annual meeting of the Radiological Society of North America
"These two trials with comparable results clearly set the stage
for the widespread adoption of and reimbursement for coronary artery CT
examinations," said Gerald D. Dodd III, M.D., chair of the Department of
Radiology at the University of Texas Health Science Center in San Antonio.
For the CORE-64 Trial (Coronary Artery Evaluation Using 64-Row Multidetector
Computed Tomography Angiography), researchers at nine international centres
studied 291 patients who were scheduled to undergo invasive coronary
angiography for suspected or unknown coronary artery disease. The study
found that 64-slice multidetector CT angiography was highly accurate in
detecting blockages of greater than 50%, with a sensitivity of 85% and a
specificity of 90%. The noninvasive exam was equal in accuracy to invasive
angiography in its ability to identify patients to be referred for
angioplasty or bypass surgery.
"Reliable assessment of the presence of
coronary blockages and accurate prediction of coronary revascularizations
are feasible with 64-slice CT coronary angiography," said presenter Marc
Dewey, M.D., radiologist at Humboldt University Berlin, Charité, Germany.
"Patients with low to intermediate risk of having coronary blockages are
most likely to benefit from coronary CT angiography, since in those patients
the necessity of invasive angiography is greatly reduced."
Trial (assessment by coronary computed tomographic angiography of
individuals undergoing invasive coronary angiography) compared 64-row
coronary computed tomographic angiography (CCTA) to quantitative coronary
angiography (QCA). The results demonstrated that CCTA is highly accurate in
detecting coronary blockages in chest pain patients referred for invasive
coronary angiography and is also an effective noninvasive method to exclude
obstructive coronary blockages.
Sixteen institutions performed CCTA on 232
patients with typical or atypical chest pain prior to invasive coronary
angiography. Findings were then compared to those of QCA, the reference
standard used to quantify the results of the invasive coronary angiography.
A total of 82 blockages greater than 50% in 49 patients and 31 blockages
greater than 70% were detected in 28 patients by QCA. Per-patient
sensitivity and specificity of CCTA were 93% and 82%, respectively, for
blockages greater than 50%, and 91% and 84% for blockages greater than 70%.
In addition, negative predictive value was 97 to 99%.
"In a population of
chest pain patients with a low to intermediate prevalence of obstructive
coronary artery blockages, CCTA performed highly accurately compared to
invasive coronary angiography," said presenter James K. Min, M.D., assistant
professor of radiology and medicine at New York Presbyterian Hospital and
director of the Cardiac Computed Tomography Laboratory and Cornell
University Medical Center. "These findings demonstrate the high diagnostic
performance of CCTA."
The 2007 meeting of the
Radiological Society of North America (RSNA):
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