Coronary artery diseaseAnalytic Approaches to Establish the Diagnostic Accuracy of Coronary Computed Tomography Angiography as a Tool for Clinical Decision Making
Section snippets
Methods
We included subjects who were referred for coronary CTA and subsequently underwent invasive coronary angiography within 4 weeks of CT from January to August 2005. All patients who underwent previous coronary artery bypass grafting were excluded from the study. Clinical data, including demographics and co-morbidities, were collected using medical record review. The institutional review board approved the study.
According to our standard protocol, all patients with a heart rate >60 beats/min
Results
Overall, we included 37 patients in the study (29 men; mean age 63 ± 11 years). Patient characteristics are listed in Table 1. Of the total 576 segments, we assessed 546 matching segments for the presence of stenosis, because 30 segments after occlusion were excluded from analysis. Fifteen percent of segments (83 of 546) and 78% of patients (29 of 37) showed significant stenosis. Invasive coronary angiography detected 13 patients (35%) with single-vessel disease, 12 patients (32%) with 2-vessel
Discussion
In this study, we show that test characteristics of coronary CTA for the detection of significant stenosis in a high-risk population change considerably depending on the “treatment” of unassessable segments. Specifically, our data suggest that PPV decreases dramatically (96% to 60%) if unassessable segments are considered not able to exclude a stenosis and thus counted as positive. Conversely, assuming unassessable segments were negative for a significant stenosis, NPV decreased from 98% to 94%
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Cited by (0)
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Dr. Shapiro, Dr. Butler, and Dr. Ferencik were supported by Grant No. 1T32 HL076136-02 from the National Institutes of Health, Bethesda, Maryland.