High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography

• Published in: Circulation (New York, N.Y.) Vol. 112; no. 15; pp. 2318 - 2323
• Main Authors: MOLLET, Nico R, CADEMARTIRI, Filippo, VAN MIEGHEM, Carlos A. G, RUNZA, Giuseppe, MCFADDEN, Eugène P, BAKS, Timo, SERRUYS, Patrick W, KRESTIN, Gabriel P, DE FEYTER, Pim J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 11.10.2005
• Subjects: Aged; Arrhythmias, Cardiac - diagnostic imaging; Arrhythmias, Cardiac - physiopathology; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Contrast Media - adverse effects; Coronary Angiography - methods; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Heart Rate; Humans; Image Processing, Computer-Assisted; Male; Medical sciences; Middle Aged; Pneumology; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Sensitivity and Specificity; Tomography, Spiral Computed - methods; Human; High resolution; Angiography; angina; Cardiovascular disease; Helical computed tomography; Coronary arteriography; Angina pectoris; Coronary heart disease; imaging; coronary disease; Tomography; Diagnosis
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.105.533471

The diagnostic performance of the latest 64-slice CT scanner, with increased temporal (165 ms) and spatial (0.4 mm3) resolution, to detect significant stenoses in the clinically relevant coronary tree is unknown. We studied 52 patients (34 men; mean age, 59.6+/-12.1 years) with atypical chest pain, stable or unstable angina pectoris, or non-ST-segment elevation myocardial infarction scheduled for diagnostic conventional coronary angiography. All patients had stable sinus rhythm. Patients with initial heart rates > or =70 bpm received beta-blockers. Mean scan time was 13.3+/-0.9 seconds. The CT scans were analyzed by 2 observers unaware of the results of invasive coronary angiography, which was used as the standard of reference. All available coronary segments, regardless of size, were included in the evaluation. Lesions with > or =50 luminal narrowing were considered significant stenoses. Invasive coronary angiography demonstrated the absence of significant disease in 25% (13 of 52), single-vessel disease in 31% (16 of 52), and multivessel disease in 45% (23 of 52) of patients. One unsuccessful CT scan was classified as inconclusive. Ninety-four significant stenoses were present in the remaining 51 patients. Sensitivity, specificity, and positive and negative predictive values of CT for detecting significant stenoses on a segment-by-segment analysis were 99% (93 of 94; 95% CI, 94 to 99), 95% (601 of 631; 95% CI, 93 to 96), 76% (93 of 123; 95% CI, 67 to 89), and 99% (601 of 602; 95% CI, 99 to 100), respectively. Noninvasive 64-slice CT coronary angiography accurately detects coronary stenoses in patients in sinus rhythm and presenting with atypical chest pain, stable or unstable angina, or non-ST-segment elevation myocardial infarction.