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

被引：197

作者：

Arbab-Zadeh, Armin ^{[1
]}

Miller, Julie M. ^{[1
]}

Rochitte, Carlos E. ^{[3
]}

Dewey, Marc ^{[4
]}

Niinuma, Hiroyuki ^{[5
]}

Gottlieb, Ilan ^{[6
]}

Paul, Narinder ^{[7
]}

Clouse, Melvin E. ^{[8
]}

Shapiro, Edward P. ^{[1
]}

Hoe, John ^{[9
]}

Lardo, Albert C. ^{[1
]}

Bush, David E. ^{[1
]}

de Roos, Albert ^{[10
]}

Cox, Christopher ^{[2
]}

Brinker, Jeffrey ^{[1
]}

Lima, Joao A. C. ^{[1
]}

机构：

[1] Johns Hopkins Univ, Div Cardiol, Baltimore, MD 21287 USA

[2] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD 21287 USA

[3] Inst Coracao, Div Cardiol, Sao Paulo, Brazil

[4] Charite, Dept Radiol, Berlin, Germany

[5] St Lukes Int Hosp, Div Cardiol, Tokyo, Japan

[6] Univ Fed Rio de Janeiro, Div Cardiol, Rio De Janeiro, Brazil

[7] Toronto Gen Hosp, Dept Radiol, Toronto, ON M5G 2C4, Canada

[8] Beth Israel Deaconess Med Ctr, Dept Radiol, Boston, MA 02215 USA

[9] Mt Elizabeth Hosp, CT Ctr, Singapore, Singapore

[10] Leiden Univ, Dept Radiol, Leiden, Netherlands

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2012年 / 59卷 / 04期

关键词：

angiography; coronary artery disease; imaging; AMERICAN-HEART-ASSOCIATION; INTERMEDIATE; PERFORMANCE; RADIOLOGY; SCORE;

D O I：

10.1016/j.jacc.2011.06.079

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (J Am Coll Cardiol 2012; 59: 379-87) (C) 2012 by the American College of Cardiology Foundation

引用

页码：379 / 387

页数：9

共 17 条

[1] Abbara Suhny, 2009, J Cardiovasc Comput Tomogr, V3, P190, DOI 10.1016/j.jcct.2009.03.004
[2] Diagnostic Performance of 64-Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease
Budoff, Matthew J.
Dowe, David
Jollis, James G.
Gitter, Michael
Sutherland, John
Halamert, Edward
Scherer, Markus
Bellinger, Raye
Martin, Arthur
Benton, Robert
Delago, Augustin
Min, James K.
[J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2008, 52 (21) : 1724 - 1732
[3] Assessment of coronary artery disease by cardiac computed tomography - A scientific statement from the American Heart Association committee on cardiovascular imaging and intervention, council on cardiovascular radiology and intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology
Budoff, Matthew J.
Achenbach, Stephan
Blumenthal, Roger S.
Carr, J. Jeffrey
Goldin, Jonathan G.
Greenland, Philip
Guerci, Alan D.
Lima, Joao A. C.
Rader, Daniel J.
Rubin, Geoffrey D.
Shaw, Leslee J.
Wiegers, Susan E.
[J]. CIRCULATION, 2006, 114 (16) : 1761 - 1791
[4] Non-invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores
Cordeiro, MAS
Miller, JM
Schmidt, A
Lardo, AC
Rosen, BD
Bush, DE
Brinker, JA
Bluemke, DA
Shapiro, EP
Lima, JAC
[J]. HEART, 2006, 92 (05) : 589 - 597
[5] Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis
Garcia, Mario J.
Lessick, Jonathan
Hoffmann, Martin H. K.
[J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2006, 296 (04): : 403 - 411
[6] The Absence of Coronary Calcification Does Not Exclude Obstructive Coronary Artery Disease or the Need for Revascularization in Patients Referred for Conventional Coronary Angiography
Gottlieb, Ilan
Miller, Julie M.
Arbab-Zadeh, Armin
Dewey, Marc
Clouse, Melvin E.
Sara, Leonardo
Niinuma, Hiroyuki
Bush, David E.
Paul, Narinder
Vavere, Andrea L.
Texter, John
Brinker, Jeffery
Lima, Joao A. C.
Rochitte, Carlos E.
[J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2010, 55 (07) : 627 - 634
[7] Hecht Harvey S, 2008, J Cardiovasc Comput Tomogr, V2, P183, DOI 10.1016/j.jcct.2008.04.003
[8] Comparison of diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low, intermediate, and high cardiovascular risk
Husmann, Lars
Schepis, Tiziano
Scheffel, Hans
Gaemperli, Oliver
Leschka, Sebastian
Valenta, Ines
Koepfli, Pascal
Desbiolles, Lotus
Stolzmann, Paul
Marincek, Borut
Alkadhi, Hatem
Kaufmann, Philipp A.
[J]. ACADEMIC RADIOLOGY, 2008, 15 (04) : 452 - 461
[9] 64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease
Meijboom, W. Bob
van Mieghem, Carlos A. G.
Mollet, Nico R.
Pugliese, Francesca
Weustink, Annick C.
van Pelt, Niels
Cademartiri, Filippo
Nieman, Koen
Boersma, Eric
de Jaegere, Peter
Krestin, Gabriel P.
de Feyter, Pim J.
[J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 50 (15) : 1469 - 1475
[10] Diagnostic Accuracy of 64-Slice Computed Tomography Coronary Angiography
Meijboom, W. Bob
Meijs, Matthijs F. L.
Schuijf, Joanne D.
Cramer, Maarten J.
Mollet, Nico R.
van Mieghem, Carlos A. G.
Nieman, Koen
van Werkhoven, Jacob M.
Pundziute, Gabija
Weustink, Annick C.
de Vos, Alexander M.
Pugliese, Francesca
Rensing, Benno
Jukema, J. Wouter
Bax, Jeroen J.
Prokop, Mathias
Doevendans, Pieter A.
Hunink, Myriam G. M.
Krestin, Gabriel P.
de Feyter, Pim J.
[J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2008, 52 (25) : 2135 - 2144

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