Document Detail

Diagnostic accuracy and impact of computed tomographic coronary angiography on utilization of invasive coronary angiography.
MedLine Citation:
PMID:  19808560     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Computed tomographic coronary angiography (CTA), given its high negative predictive value, is a potential gatekeeper for invasive coronary angiography (ICA). Before CTA can be further accepted into clinical practice, its impact on healthcare resources needs to be better understood. We sought to determine the clinical impact of CTA on ICA referrals, CTA accuracy, and normalcy rate. METHODS AND RESULTS: To determine the impact of CTA, consecutive patients (n=7017) undergoing ICA before and after implementing a dedicated cardiac CT program were reviewed and compared with 3 other centers (n=11 508). To determine CTA accuracy, we evaluated consecutive CTA patients who underwent ICA. For normalcy rate, we identified patients with a low pretest probability for obstructive coronary artery disease. With the implementation of a cardiac CT program, the frequency of normal ICA decreased from 31.5% (1114 of 3538 patients) to 26.8% (932 of 3479 patients) (P<0.001). These findings were significantly different (P=0.003) from the 3 centers, in which normal ICAs were unchanged (30.0% [1870 of 6224 patients] to 31.0% [1642 of 5284 patients]). CTA had excellent per-patient sensitivity (99% [CI, 95% to 100%]), positive predictive value (92% [CI, 86% to 96%]) and negative predictive value (95% [CI, 72% to 100%]). Because of referral bias, specificity (64% [CI, 44% to 81%]) was low; however, the normalcy rate of CTA was 94% (CI, 90% to 97%). After adjusting for referral bias, the adjusted sensitivity was 90% (CI, 89% to 91%), and the adjusted specificity was 95% (CI, 94% to 96%), with positive and negative predictive values of 92% (CI, 91% to 93%) and 93% (CI, 92% to 94%), respectively. CONCLUSIONS: The clinical implementation of CTA appears to positively impact ICA by reducing the frequency of normal ICA. The operating characteristics of CTA support its potential role as a tool useful in ruling out obstructive coronary artery disease.
Benjamin J W Chow; Arun Abraham; George A Wells; Li Chen; Terrence D Ruddy; Yeung Yam; Nayia Govas; Phoebe Diane Galbraith; Carole Dennie; Rob S Beanlands
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  2     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2009-10-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  16-23     Citation Subset:  IM    
Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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MeSH Terms
Coronary Angiography*
Coronary Artery Disease / radiography*
Middle Aged
Predictive Value of Tests
Sensitivity and Specificity
Tomography, X-Ray Computed*
Comment In:
Circ Cardiovasc Imaging. 2009 Jan;2(1):1-3   [PMID:  19808556 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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