The incremental diagnostic performance of coronary computed tomography angiography added to myocardial perfusion imaging in patients with intermediate-to-high cardiovascular risk
Journal
Acta Cardiologica Sinica
Journal Volume
32
Journal Issue
2
Pages
145-155
Date Issued
2016
Author(s)
Abstract
Purpose: Several studies have suggested that a combined approach of stress myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) can provide diagnostic results with excellent accuracy. We aimed to explore whether the addition of CCTA to stress MPI provides incremental diagnostic value in intermediate-to-high cardiovascular risk patients. Methods: A total of 106 consecutive patients (93 male, 65 ± 10.4 years) underwent coronary artery calcium scoring (CACS), CCTA and 201Thallium stressMPI before coronary angiography was reviewed. Thirty-seven patients (34.9%) had a history of proven coronary artery disease (CAD) or revascularization procedures, and four had documented non-significant CAD (3.8%). The remaining patients consisted of 17 (16.0%) classified as intermediate, and 48 (45.3%) as the high-risk groups. Results: Obstructive CAD was diagnosed by invasive coronary angiography in 88 patients with 161 vessels. The sensitivity and specificity in a patient-based analysis for obstructive CADwere 99% and 17% for CCTA, 80% and 50% for MPI and 91% and 67% for the combined method, respectively. The per-vessel diagnostic sensitivity and specificity were 95% and 54% for CCTA, 59% and 75% for MPI and 84% and 76% for the combined method. There were significant differences (p < 0.05) when comparing the combined method with MPI or CCTA by areas under the curve in a patient-or vessel-based analysis. However, CACS of 400 or more could not further stratify the patients with obstructive CAD. Conclusions: CCTA, not CACS, provided additional diagnostic values to stress MPI in patients with intermediateto-high cardiovascular risk. ? 2016, Republic of China Society of Cardiology. All rights reserved.
SDGs
Other Subjects
dipyridamole; adult; aged; Article; cardiovascular risk; computed tomographic angiography; coronary angiography; coronary artery calcium score; diagnostic test accuracy study; diagnostic value; female; heart muscle revascularization; human; image quality; major clinical study; male; multidetector computed tomography; myocardial perfusion imaging; predictive value; retrospective study; sensitivity and specificity; single photon emission computer tomography; stenosis
Type
journal article