Document Detail

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 Study.
MedLine Citation:
PMID:  22261160     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to assess the impact of patient population characteristics on accuracy by computed tomography angiography (CTA) to detect obstructive coronary artery disease (CAD).
BACKGROUND: The ability of CTA to exclude obstructive CAD in patients of different pre-test probabilities and in presence of coronary calcification remains uncertain.
METHODS: For the CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) study, 371 patients underwent CTA and cardiac catheterization for the detection of obstructive CAD, defined as ≥50% luminal stenosis by quantitative coronary angiography (QCA). This analysis includes 80 initially excluded patients with a calcium score ≥600. Area under the receiver-operating characteristic curve (AUC) was used to evaluate CTA diagnostic accuracy compared to QCA in patients according to calcium score and pre-test probability of CAD.
RESULTS: Analysis of patient-based quantitative CTA accuracy revealed an AUC of 0.93 (95% confidence interval [CI]: 0.90 to 0.95). The AUC remained 0.93 (95% CI: 0.90 to 0.96) after excluding patients with known CAD but decreased to 0.81 (95% CI: 0.71 to 0.89) in patients with calcium score ≥600 (p = 0.077). While AUCs were similar (0.93, 0.92, and 0.93, respectively) for patients with intermediate, high pre-test probability for CAD, and known CAD, negative predictive values were different: 0.90, 0.83, and 0.50, respectively. Negative predictive values decreased from 0.93 to 0.75 for patients with calcium score <100 or ≥100, respectively (p = 0.053).
CONCLUSIONS: Both pre-test probability for CAD and coronary calcium scoring should be considered before using CTA for excluding obstructive CAD. For that purpose, CTA is less effective in patients with calcium score ≥600 and in patients with a high pre-test probability for obstructive CAD.
Armin Arbab-Zadeh; Julie M Miller; Carlos E Rochitte; Marc Dewey; Hiroyuki Niinuma; Ilan Gottlieb; Narinder Paul; Melvin E Clouse; Edward P Shapiro; John Hoe; Albert C Lardo; David E Bush; Albert de Roos; Christopher Cox; Jeffrey Brinker; Joăo A C Lima
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  59     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-20     Completed Date:  2012-03-12     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  379-87     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Division of Cardiology, Johns Hopkins University, Baltimore, MD 21287, USA.
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MeSH Terms
Coronary Angiography
Coronary Artery Disease / radiography*
Coronary Stenosis / radiography*
Middle Aged
Multidetector Computed Tomography
Predictive Value of Tests
Vascular Calcification / radiography*
Grant Support
Comment In:
J Am Coll Cardiol. 2012 Aug 14;60(7):642; author reply 642-3   [PMID:  22878169 ]
J Am Coll Cardiol. 2012 Jan 24;59(4):388-9   [PMID:  22261161 ]

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