Recommended Conferences

Clinical Pharmacy and Pharmacology

Paris, France
 

Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial

Author(s): Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, et al.

Abstract

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 > or =50% or > 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 < or =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).

Similar Articles

Physiological basis of clinically used coronary hemodynamic indices

Author(s): Spaan JA, Piek JJ, Hoffman JI, Siebes M

Pressure-flow relations in coronary circulation

Author(s): Hoffman JI, Spaan JA

Pathophysiology of coronary artery disease

Author(s): Libby P, Theroux P

Multicentric inflammation in epicardial coronary arteries of patients dying of acute myocardial infarction

Author(s): Spagnoli LG, Bonanno E, Mauriello A, Palmieri G, Partenzi A, et al.

Chest pain relief by nitroglycerin does not predict active coronary artery disease

Author(s): Henrikson CA, Howell EE, Bush DE, Miles JS, Meininger GR, et al.

Exercise-induced ST depression in the diagnosis of coronary artery disease

Author(s): Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P, et al.

Effect of myocardial ischemia on cardiac troponin I and T

Author(s): Carlson RJ, Navone A, McConnell JP, Burritt M, Castle MC, et al.

Prevalence and determinants of troponin T elevation in the general population

Author(s): Wallace TW, Abdullah SM, Drazner MH, Das SR, Khera A, et al.

Utility of myocardial perfusion imaging in patients with low-risk treadmill scores

Author(s): Poornima IG, Miller TD, Christian TF, Hodge DO, Bailey KR, et al.

Magnetic resonance spectroscopy in myocardial disease

Author(s): Hudsmith LE, Neubauer S

Accuracy of MSCT coronary angiography with 64-slice technology: first experience

Author(s): Leschka S, Alkadhi H, Plass A, Desbiolles L, Grünenfelder J, et al.

Characteristics of coronary plaques before angiographic progression determined by Multi-Slice CT

Author(s): Leber AW, von Ziegler F, Becker A, Becker CR, Reiser M, et al.

Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography

Author(s): Ropers U, Ropers D, Pflederer T, Anders K, Kuettner A, et al.

Radiation dose in computed tomography of the heart

Author(s): Morin RL, Gerber TC, McCollough CH

Radiation exposure during cardiac CT: effective doses at multi-detector row CT and electron-beam CT

Author(s): Hunold P, Vogt FM, Schmermund A, Debatin JF, Kerkhoff G, et al.

Prognostic value of dobutamine stress myocardial contrast perfusion echocardiography

Author(s): Tsutsui JM, Elhendy A, Anderson JR, Xie F, McGrain AC, et al.

N Engl J Med 331: 489-495

Author(s): Serruys PW, de Jaegere P, Kiemeneij F, Macaya C, Rutsch W, et al.

Major clinical events after coronary stenting

Author(s): Sutton JM, Ellis SG, Roubin GS, Pinkerton CA, King SB 3rd, et al.

Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

Author(s): Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, et al.

Coronary revascularization in context

Author(s): Lange RA, Hillis LD

Coronary artery disease in Saudi Arabia

Author(s): Al-Nozha MM, Arafah MR, Al-Mazrou YY, Al-Maatouq MA, Khan NB, et al.

Diabetes mellitus in Saudi Arabia

Author(s): Al-Nozha MM, Al-Maatouq MA, Al-Mazrou YY, Al-Harthi SS, Arafah MR, et al.

Obesity in Saudi Arabia

Author(s): Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Arafah MR, Khalil MZ, et al.

Metabolic syndrome in Saudi Arabia

Author(s): Al-Nozha M, Al-Khadra A, Arafah MR, Al-Maatouq MA, Khalil MZ, et al.

Hypertension in Saudi Arabia

Author(s): Al-Nozha MM, Abdullah M, Arafah MR, Khalil MZ, Khan NB, et al.

Hyperlipidemia in Saudi Arabia

Author(s): Al-Nozha MM, Arafah MR, Al-Maatouq MA, Khalil MZ, Khan NB, et al.

Interaction between fatness and fitness on CVD risk factors in Asian youth

Author(s): Jekal Y, Kim ES, Im JA, Park JH, Lee MK, et al.

Body fatness and clustering of cardiovascular disease risk factors in Portuguese children and adolescents

Author(s): Ribeiro JC, Guerra S, Oliveira J, Andersen LB, Duarte JA, et al.

Changes in secondary prevention of coronary artery disease in the post-discharge period over the decade 1997-2007

Author(s): Pajak A, Jankowski P, Kawecka-Jaszcz K, Surowiec S, Wolfshaut R, et al.

Secondary prevention through cardiac rehabilitation: from knowledge to implementation

Author(s): Piepoli MF, Corrá U, Benzer W, Bjarnason-Wehrens B, Dendale P, et al.

Secondary prevention of coronary artery disease in hospital practice over the decade 1996-2006

Author(s): Jankowski P, Kawecka-Jaszcz K, Pajak A, Surowiec S, Wolfshaut R, et al.