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Ontario Multidetector Computed Tomographic Coronary Angiography Study: Field Evaluation of Diagnostic Accuracy.
MedLine Citation:
PMID:  21403014     Owner:  NLM     Status:  Publisher    
BACKGROUND: Computed tomographic coronary angiography (CTCA) has gained clinical acceptance for the detection of obstructive coronary artery disease. Although single-center studies have demonstrated excellent accuracy, multicenter studies have yielded variable results. The true diagnostic accuracy of CTCA in the "real world" remains uncertain. We conducted a field evaluation comparing multidetector CTCA with invasive CA (ICA) to understand CTCA's diagnostic accuracy in a real-world setting. METHODS: A multicenter cohort study of patients awaiting ICA was conducted between September 2006 and June 2009. All patients had either a low or an intermediate pretest probability for coronary artery disease and underwent CTCA and ICA within 10 days. The results of CTCA and ICA were interpreted visually by local expert observers who were blinded to all clinical data and imaging results. RESULTS: Using a patient-based analysis (diameter stenosis ≥50%) of 169 patients, the sensitivity, specificity, positive predictive value, and negative predictive value were 81.3% (95% confidence interval [CI], 71.0%-89.1%), 93.3% (95% CI, 85.9%-97.5%), 91.6% (95% CI, 82.5%-96.8%), and 84.7% (95% CI, 76.0%-91.2%), respectively; the area under receiver operating characteristic curve was 0.873. The diagnostic accuracy varied across centers (P < .001), with a sensitivity, specificity, positive predictive value, and negative predictive value ranging from 50.0% to 93.2%, 92.0% to 100%, 84.6% to 100%, and 42.9% to 94.7%, respectively. CONCLUSIONS: Compared with ICA, CTCA appears to have good accuracy; however, there was variability in diagnostic accuracy across centers. Factors affecting institutional variability need to be better understood before CTCA is universally adopted. Additional real-world evaluations are needed to fully understand the impact of CTCA on clinical care. Trial Registration Identifier: NCT00371891.
Benjamin J W Chow; Michael R Freeman; James M Bowen; Leslie Levin; Robert B Hopkins; Yves Provost; Jean-Eric Tarride; Carole Dennie; Eric A Cohen; Dan Marcuzzi; Robert Iwanochko; Alan R Moody; Narinder Paul; John D Parker; Daria J O'Reilly; Feng Xie; Ron Goeree
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-14
Journal Detail:
Title:  Archives of internal medicine     Volume:  -     ISSN:  1538-3679     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
University of Ottawa Heart Institute and Department of Radiology, University of Ottawa and Ottawa Hospital (Dr Chow), Ottawa, Ontario, Canada; Department of Medicine (Cardiology) (Dr Freeman) and Department of Radiology (Dr Marcuzzi), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine (Cardiology) (Dr Cohen) and Department of Radiology (Dr Moody), Sunnybrook Health Sciences Centre, University of Toronto; Department of Medicine (Oncology) (Dr Levin), Department of Medicine (Cardiology) (Drs Iwanochko and Parker), and Department of Medical Imaging (Dr Paul), University Health Network and Faculty of Medicine, University of Toronto; Medical Advisory Secretariat, Ontario Ministry of Health and Long-term Care, Toronto (Dr Levin); Programs for Assessment of Technology in Health Research Institute, St Joseph's Healthcare Hamilton (Mssrs Bowen, Hopkins and Goeree and Drs Tarride, O'Reilly and Xie), and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University (Mssrs Bowen, Hopkins and Goeree and Drs Tarride, O'Reilly and Xie), Hamilton, Ontario, Canada; and Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (Dr Provost).
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