TY - JOUR
T1 - Detection of Significant Coronary Artery Disease by Noninvasive Anatomical and Functional Imaging
AU - Neglia, Danilo
AU - Rovai, Daniele
AU - Caselli, Chiara
AU - Pietila, Mikko
AU - Teresinska, Anna
AU - Aguadé-Bruix, Santiago
AU - Pizzi, Maria Nazarena
AU - Todiere, Giancarlo
AU - Gimelli, Alessia
AU - Schroeder, Stephen
AU - Drosch, Tanja
AU - Poddighe, Rosa
AU - Casolo, Giancarlo
AU - Anagnostopoulos, Constantinos
AU - Pugliese, Francesca
AU - Rouzet, Francois
AU - Le Guludec, Dominique
AU - Cappelli, Francesco
AU - Valente, Serafina
AU - Gensini, Gian Franco
AU - Zawaideh, Camilla
AU - Capitanio, Selene
AU - Sambuceti, Gianmario
AU - Marsico, Fabio
AU - Perrone Filardi, Pasquale
AU - Fernández-Golfín, Covadonga
AU - Rincón, Luis M.
AU - Graner, Frank P.
AU - De Graaf, Michiel A.
AU - Fiechter, Michael
AU - Stehli, Julia
AU - Gaemperli, Oliver
AU - Reyes, Eliana
AU - Nkomo, Sandy
AU - Maki, Maija
AU - Lorenzoni, Valentina
AU - Turchetti, Giuseppe
AU - Carpeggiani, Clara
AU - Marinelli, Martina
AU - Puzzuoli, Stefano
AU - Mangione, Maurizio
AU - Marcheschi, Paolo
AU - Mariani, Fabio
AU - Giannessi, Daniela
AU - Nekolla, Stephan
AU - Lombardi, Massimo
AU - Sicari, Rosa
AU - Scholte, Arthur J.H.A.
AU - Zamorano, José L.
AU - Kaufmann, Philipp A.
AU - Underwood, S. Richard
AU - Knuuti, Juhani
N1 - Publisher Copyright:
© 2015 American Heart Association, Inc.
PY - 2015/3/21
Y1 - 2015/3/21
N2 - Background-The choice of imaging techniques in patients with suspected coronary artery disease (CAD) varies between countries, regions, and hospitals. This prospective, multicenter, comparative effectiveness study was designed to assess the relative accuracy of commonly used imaging techniques for identifying patients with significant CAD. Methods and Results-A total of 475 patients with stable chest pain and intermediate likelihood of CAD underwent coronary computed tomographic angiography and stress myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography, and ventricular wall motion imaging by stress echocardiography or cardiac magnetic resonance. If ≥1 test was abnormal, patients underwent invasive coronary angiography. Significant CAD was defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70% stenosis with fractional flow reserve ≤0.8. Significant CAD was present in 29% of patients. In a patient-based analysis, coronary computed tomographic angiography had the highest diagnostic accuracy, the area under the receiver operating characteristics curve being 0.91 (95% confidence interval, 0.88-0.94), sensitivity being 91%, and specificity being 92%. Myocardial perfusion imaging had good diagnostic accuracy (area under the curve, 0.74; confidence interval, 0.69-0.78), sensitivity 74%, and specificity 73%. Wall motion imaging had similar accuracy (area under the curve, 0.70; confidence interval, 0.65-0.75) but lower sensitivity (49%, P<0.001) and higher specificity (92%, P<0.001). The diagnostic accuracy of myocardial perfusion imaging and wall motion imaging were lower than that of coronary computed tomographic angiography (P<0.001). Conclusions-In a multicenter European population of patients with stable chest pain and low prevalence of CAD, coronary computed tomographic angiography is more accurate than noninvasive functional testing for detecting significant CAD defined invasively.
AB - Background-The choice of imaging techniques in patients with suspected coronary artery disease (CAD) varies between countries, regions, and hospitals. This prospective, multicenter, comparative effectiveness study was designed to assess the relative accuracy of commonly used imaging techniques for identifying patients with significant CAD. Methods and Results-A total of 475 patients with stable chest pain and intermediate likelihood of CAD underwent coronary computed tomographic angiography and stress myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography, and ventricular wall motion imaging by stress echocardiography or cardiac magnetic resonance. If ≥1 test was abnormal, patients underwent invasive coronary angiography. Significant CAD was defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70% stenosis with fractional flow reserve ≤0.8. Significant CAD was present in 29% of patients. In a patient-based analysis, coronary computed tomographic angiography had the highest diagnostic accuracy, the area under the receiver operating characteristics curve being 0.91 (95% confidence interval, 0.88-0.94), sensitivity being 91%, and specificity being 92%. Myocardial perfusion imaging had good diagnostic accuracy (area under the curve, 0.74; confidence interval, 0.69-0.78), sensitivity 74%, and specificity 73%. Wall motion imaging had similar accuracy (area under the curve, 0.70; confidence interval, 0.65-0.75) but lower sensitivity (49%, P<0.001) and higher specificity (92%, P<0.001). The diagnostic accuracy of myocardial perfusion imaging and wall motion imaging were lower than that of coronary computed tomographic angiography (P<0.001). Conclusions-In a multicenter European population of patients with stable chest pain and low prevalence of CAD, coronary computed tomographic angiography is more accurate than noninvasive functional testing for detecting significant CAD defined invasively.
KW - coronary artery disease
KW - coronary computed tomography angiography
KW - echocardiography
KW - magnetic resonance imaging
KW - myocardial perfusion imaging
KW - positron emission tomography
KW - single photon computed emission tomography
UR - http://www.scopus.com/inward/record.url?scp=84927173479&partnerID=8YFLogxK
U2 - 10.1161/CIRCIMAGING.114.002179
DO - 10.1161/CIRCIMAGING.114.002179
M3 - Article
C2 - 25711274
AN - SCOPUS:84927173479
SN - 1941-9651
VL - 8
JO - Circulation: Cardiovascular Imaging
JF - Circulation: Cardiovascular Imaging
IS - 3
M1 - e002179
ER -