Computed tomographic coronary angiographic assessment of high-risk coronary anatomy in patients with suspected coronary artery disease and intermediate pretest probability - 09/08/11
, Shoaib Amlani, MD, FACC, Mary Lou Ellins, MD, FRCPC, Shamir Mehta, MD, MSc, FRCPC, James Velianou, MD, FRCPC, Gail Cappelli, BSc, RN, Sean Yang, MSc, Madhu Natarajan, MD, FRCPCRésumé |
Background |
It is unclear if computed tomographic coronary angiography (CTA), an evolving technique for the evaluation of coronary artery disease (CAD), can identify patients with high-risk coronary anatomy.
Methods |
Among patients referred for invasive angiography at Hamilton Health Sciences (Hamilton, Ontario, Canada), those with an intermediate pretest probability (25%-60% likelihood of a significant stenosis) were prospectively identified using a multivariate risk score and were studied on a 64-detector Toshiba Aquilion scanner (Toshiba Medical Systems, Tokyo, Japan) before invasive angiography. Patients with high-risk anatomy (left main, 3-vessel CAD, or 2-vessel CAD involving the proximal left anterior descending artery) or at least 1 significant stenosis were identified on CTA and invasive angiography, and the results of these modalities were compared on a per patient basis.
Results |
Eighty patients were enrolled in the study (mean age 56 ± 9 years, male-female ratio 43:37). Nondiagnostic scan results were obtained in 5 patients (6%). By CTA, 13 patients had high-risk anatomy and 31 patients had at least 1 significant stenosis. For the per patient detection of high-risk anatomy, CTA had 100% sensitivity (95% CI 69%-100%), 95% specificity (95% CI 86%-95%), a positive likelihood ratio of 18.0 (95% CI 6.4-50.3), and a negative likelihood ratio of 0.05 (95% CI 0-0.072). Revascularization was performed in 100% of patients with high-risk anatomy on CTA, 83% with at least 1 significant stenosis on CTA, and 0% without a significant stenosis on CTA.
Conclusion |
In appropriately selected patients, CTA is a highly sensitive and specific technique for the detection of high-risk anatomy and maybe a valuable method for noninvasive risk stratification.
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| This study was supported by a grant from the Hamilton Health Science Investigator Fund. |
Vol 155 - N° 5
P. 918-923 - mai 2008 Retour au numéro
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