| 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. | |
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MedLine Citation:
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PMID: 22261160 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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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:
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Created Date: 2012-01-20 Completed Date: 2012-03-12 Revised Date: 2013-04-05 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 379-87 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Division of Cardiology, Johns Hopkins University, Baltimore, MD 21287, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Coronary Angiography Coronary Artery Disease / radiography* Coronary Stenosis / radiography* Female Humans Male Middle Aged Multidetector Computed Tomography Predictive Value of Tests Vascular Calcification / radiography* |
| Grant Support | |
ID/Acronym/Agency:
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HO1-HC95162-01/HC/NHLBI NIH HHS; N01HC95168/HL/NHLBI NIH HHS; R01-AG021570-01/AG/NIA NIH HHS; R01-HL66075-01/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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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 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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