Diagnostic accuracy of Computed Tomography Coronary Angiography in a high risk symptomatic population

Abstract

Objective: To evaluate the diagnostic accuracy of 64-slice computed tomography (CT) coronary angiography (CA) for the detection of significant coronary artery stenosis (≥50% lumen reduction) as compared to invasive coronary angiography (ICA) in a population of patients with chest pain and high risk. Materials and methods: 44 patients (30 male; mean age 60.2±12.1yrs) with chest pain were prospectively enrolled. In patients with heart rate ≥70 bpm an oral dose of 100 mg of b-blocker was administered. For CT-CA (Sensation 64, Siemens, Germany) an intravenous bolus of 100 ml of iodinated contrast material (Iomeron 400, Bracco, Italy) was injected. The average scan time was 13.3±0.9s. Two observers evaluated CT-CA vs. ICA as a reference standard for the detection of significant (≥50% lumen reduction) coronary artery stenosis. Results: ICA demonstrated the absence of coronary artery disease (CAD) in 13.6% of the patients (6/44), the presence of non significant CAD 4.6% (2/44), single vessel disease in 27.2% (12/44) and multi-vessel disease in 54.6% (24/44) of the patients. None of the patients was excluded from the study population. Ninety-three significant obstructive coronary lesions were observed. Sensitivity, specificity, positive and negative predictive value of CT-CA were 98.6% (70/71), 92.4% (97/105), 89.7% (70/78) and 99% (97/98), respectively. All patients with at least one significant coronary lesion were correctly identified by CT-CA. Conclusions: CT-CA is a reliable alternative to ICA in a selected population of patients with chest pain and high risk.