Detection of Significant Coronary Artery Disease by Noninvasive Anatomical and Functional Imaging
Top Cited Papers
Open Access
- 1 March 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Imaging
Abstract
Background— The choice of imaging techniques in patients with suspected coronary artery disease (CAD) varies between countries, regions, and hospitals. This prospective, multicenter, comparative effectiveness study was designed to assess the relative accuracy of commonly used imaging techniques for identifying patients with significant CAD. Methods and Results— A total of 475 patients with stable chest pain and intermediate likelihood of CAD underwent coronary computed tomographic angiography and stress myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography, and ventricular wall motion imaging by stress echocardiography or cardiac magnetic resonance. If ≥1 test was abnormal, patients underwent invasive coronary angiography. Significant CAD was defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70% stenosis with fractional flow reserve ≤0.8. Significant CAD was present in 29% of patients. In a patient-based analysis, coronary computed tomographic angiography had the highest diagnostic accuracy, the area under the receiver operating characteristics curve being 0.91 (95% confidence interval, 0.88–0.94), sensitivity being 91%, and specificity being 92%. Myocardial perfusion imaging had good diagnostic accuracy (area under the curve, 0.74; confidence interval, 0.69–0.78), sensitivity 74%, and specificity 73%. Wall motion imaging had similar accuracy (area under the curve, 0.70; confidence interval, 0.65–0.75) but lower sensitivity (49%, PPP<0.001). Conclusions— In a multicenter European population of patients with stable chest pain and low prevalence of CAD, coronary computed tomographic angiography is more accurate than noninvasive functional testing for detecting significant CAD defined invasively. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979199.Keywords
This publication has 33 references indexed in Scilit:
- Coronary Computed Tomography Angiography After Stress Testing: Results From a Multicenter, Statewide Registry, ACIC (Advanced Cardiovascular Imaging Consortium)Journal of the American College of Cardiology, 2012
- Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trialThe Lancet, 2012
- Diagnostic Accuracy of Computed Tomography Coronary Angiography According to Pre-Test Probability of Coronary Artery Disease and Severity of Coronary Arterial Calcification: The CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) International Multicenter StudyJournal of the American College of Cardiology, 2012
- Meta-analysis of the diagnostic performance of stress perfusion cardiovascular magnetic resonance for detection of coronary artery diseaseJournal of Cardiovascular Magnetic Resonance, 2010
- Stress/Rest Myocardial Perfusion Abnormalities by Gated SPECT: Still the Best Predictor of Cardiac Events in Stable Ischemic Heart DiseaseJournal of Nuclear Medicine, 2009
- Noninvasive Coronary Artery ImagingCirculation, 2008
- EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiologyEuropean Journal of Nuclear Medicine and Molecular Imaging, 2005
- Prognostic Value of Pharmacological Stress Echocardiography Is Affected by Concomitant Antiischemic Therapy at the Time of TestingCirculation, 2004
- Analysis of Probability as an Aid in the Clinical Diagnosis of Coronary-Artery DiseaseThe New England Journal of Medicine, 1979