| Diagnostic performance of coronary angiography by 64-row CT. | |
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MedLine Citation:
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PMID: 19038879 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The accuracy of multidetector computed tomographic (CT) angiography involving 64 detectors has not been well established. METHODS: We conducted a multicenter study to examine the accuracy of 64-row, 0.5-mm multidetector CT angiography as compared with conventional coronary angiography in patients with suspected coronary artery disease. Nine centers enrolled patients who underwent calcium scoring and multidetector CT angiography before conventional coronary angiography. In 291 patients with calcium scores of 600 or less, segments 1.5 mm or more in diameter were analyzed by means of CT and conventional angiography at independent core laboratories. Stenoses of 50% or more were considered obstructive. The area under the receiver-operating-characteristic curve (AUC) was used to evaluate diagnostic accuracy relative to that of conventional angiography and subsequent revascularization status, whereas disease severity was assessed with the use of the modified Duke Coronary Artery Disease Index. RESULTS: A total of 56% of patients had obstructive coronary artery disease. The patient-based diagnostic accuracy of quantitative CT angiography for detecting or ruling out stenoses of 50% or more according to conventional angiography revealed an AUC of 0.93 (95% confidence interval [CI], 0.90 to 0.96), with a sensitivity of 85% (95% CI, 79 to 90), a specificity of 90% (95% CI, 83 to 94), a positive predictive value of 91% (95% CI, 86 to 95), and a negative predictive value of 83% (95% CI, 75 to 89). CT angiography was similar to conventional angiography in its ability to identify patients who subsequently underwent revascularization: the AUC was 0.84 (95% CI, 0.79 to 0.88) for multidetector CT angiography and 0.82 (95% CI, 0.77 to 0.86) for conventional angiography. A per-vessel analysis of 866 vessels yielded an AUC of 0.91 (95% CI, 0.88 to 0.93). Disease severity ascertained by CT and conventional angiography was well correlated (r=0.81; 95% CI, 0.76 to 0.84). Two patients had important reactions to contrast medium after CT angiography. CONCLUSIONS: Multidetector CT angiography accurately identifies the presence and severity of obstructive coronary artery disease and subsequent revascularization in symptomatic patients. The negative and positive predictive values indicate that multidetector CT angiography cannot replace conventional coronary angiography at present. (ClinicalTrials.gov number, NCT00738218.) |
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Authors:
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Julie M Miller; Carlos E Rochitte; Marc Dewey; Armin Arbab-Zadeh; 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; Jeffery Brinker; João A C Lima |
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Publication Detail:
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Type: Clinical Trial; 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: The New England journal of medicine Volume: 359 ISSN: 1533-4406 ISO Abbreviation: N. Engl. J. Med. Publication Date: 2008 Nov |
Date Detail:
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Created Date: 2008-11-28 Completed Date: 2008-12-04 Revised Date: 2009-05-11 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: United States |
Other Details:
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Languages: eng Pagination: 2324-36 Citation Subset: AIM; IM |
Copyright Information:
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2008 Massachusetts Medical Society |
Affiliation:
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Johns Hopkins University School of Medicine, Baltimore 21287, USA. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00738218 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angina Pectoris / classification, radiography Area Under Curve Coronary Angiography* / adverse effects Coronary Artery Disease / radiography* Female Humans Male Middle Aged Predictive Value of Tests ROC Curve Sensitivity and Specificity Severity of Illness Index Single-Blind Method Technology Assessment, Biomedical Tomography, X-Ray Computed* / adverse effects, methods |
| Grant Support | |
ID/Acronym/Agency:
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H01-HC95162-01/HC/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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N Engl J Med. 2009 May 7;360(19):2028; author reply 2029-30
[PMID:
19425238
]
N Engl J Med. 2009 May 7;360(19):2027-8; author reply 2029-30 [PMID: 19425237 ] N Engl J Med. 2008 Nov 27;359(22):2309-11 [PMID: 19038877 ] N Engl J Med. 2009 May 7;360(19):2028; author reply 2029-30 [PMID: 19425193 ] N Engl J Med. 2009 May 7;360(19):2027; author reply 2029-31 [PMID: 19420375 ] |
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