128-Detector-Row Computed Tomography Coronary Angiography Evaluating Coronary Artery Disease: Who Avoids Cardiac Catheterization?

Abstract

Purpose: To evaluate the prevalence of significant coronary artery disease (CAD) and nondiagnostic studies in patients referred for clinically indicated coronary angiography performed by 128 multidetector computed tomography (MDCT).Methods: We examined patients referred for coronary computed tomography (CT) angiography for the presence of CAD. The analysis included 438 studies classified as normal, with nonsignificant CAD, with significant CAD, or nondiagnostic.Results: Of the 438 cases evaluated, 121 (27.6%) cases were reported as normal, 184 (42%) were classified as nonsignificant CAD, 92 (21%) as significant CAD, and 41 (9.3%) were inconclusive. Therefore, 69.7% of the study population most probably did not require conventional coronary angiography.Conclusion: Among patients referred for computed tomography angiography (CTA) for appropriate indications, 69.6% had either normal coronary arteries or nonobstructive disease. Given the high negative predictive value of coronary CTA, these patients most likely would not require invasive coronary angiography. Selective cardiac CTA may substantially decrease unnecessary diagnostic cardiac catheterizations.

Keywords

coronary artery disease noninvasive CT angiography multidetector computed tomography

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References

Budoff MJ , Gopal A. , Gul KM , Mao SS , Fischer H. , Oudiz RJ Prevalence of obstructive coronary artery disease in an outpatient cardiac CT angiography environment. Int J Cardiol. 2008;129(1):32-36.

Mollet NR , Cademartiri F. , Nieman K. , et al. Noninvasive assessment of coronary plaque burden using multislice computed tomography. Am J Cardiol. 2005;95(10):1165-1169.

Raff GL , Gallagher MJ , O’Neill WW , Goldstein JA Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol. 2005 ;46(3):552-557.

Leber AW , Knez A. , Becker A. , et al. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. J Am Coll Cardiol. 2004;43(7):1241-1247.

Leschka S. , Alkadhi H. , Plass A. , et al. Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J. 2005;26(15):1482-1487.

Budoff MJ , Lu B. , Shinbane JS , et al. Methodology for improved detection of coronary stenoses with computed tomographic angiography. Am Heart J. 2004;148(6):1085-1090.

Hendel RC , Patel MR , Kramer CM , et al. ACCF/ACR/ SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006;48(7):1475-1497.

Budoff MJ , Achenbach S. , Blumenthal RS , et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 2006;114(16):1761-1791.

Becker CR Coronary CT angiography in symptomatic patients. Eur Radiol. 2005;15(suppl 2):B33-B41.

10.

Butler J. , Shapiro M. , Reiber J. , et al. Extent and distribution of coronary artery disease: a comparative study of invasive versus noninvasive angiography with computed angiography . Am Heart J. 2007;153(3):378-384.

11.

Nikolaou K. , Knez A. , Rist C. , et al. Accuracy of 64-MDCT in the diagnosis of ischemic heart disease. AJR Am J Roentgenol. 2006;187(1):111-117.

12.

Muhlenbruch G. , Seyfarth T. , Soo CS , Pregalathan N. , Mahnken AH Diagnostic value of 64-slice multi-detector row cardiac CTA in symptomatic patients. Eur Radiol. 2007;17(3):603-609.

13.

Gaemperli O. , Schepis T. , Koepfli P. , et al. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging. 2007;34(8):1162-1171.

14.

Achenbach S. Computed tomography coronary angiography. J Am Coll Cardiol. 2006;48(10):1919-1928.

15.

Budoff MJ , Achenbach S. , Duerinckx A. Clinical utility of computed tomography and magnetic resonance techniques for noninvasive coronary angiography. J Am Coll Cardiol. 2003;42(11):1867-1878.

16.

Noto TJ, Jr. , Johnson LW , Krone R. , et al. Cardiac catheterization 1990: a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA&I) . Cathet Cardiovasc Diagn. 1991;24(2):75-83.

17.

Budoff MJ Noninvasive coronary angiography using computed tomography. Expert Rev Cardiovasc Ther. 2005;3(1):123-132.

18.

Finet G. , Ohayon J. , Rioufol G. , et al. Morphological and biomechanical aspects of vulnerable coronary plaque. Arch Mal Coeur Vaiss. 2007;100(6-7):547-553.

19.

Ueno K. , Anzai T. , Jinzaki M. , et al. Diagnostic capacity of 64-slice multidetector computed tomography for acute coronary syndrome in patients presenting with acute chest pain. Cardiology. 2008;112(3):211-218.

20.

Schlosser T. , Mohrs OK , Magedanz A. , et al. Noninvasive coronary angiography using 64-detector-row computed tomography in patients with a low to moderate pretest probability of significant coronary artery disease. Acta Radiol . 2007;48(3):300-307.