TY - JOUR
T1 - Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease
T2 - The Coronary Angiography by Computed Tomography with the Use of a Submillimeter resolution (CACTUS) trial
AU - Hausleiter, Jörg
AU - Meyer, Tanja
AU - Hadamitzky, Martin
AU - Zankl, Maria
AU - Gerein, Pia
AU - Dörrler, Katharina
AU - Kastrati, Adnan
AU - Martinoff, Stefan
AU - Schömig, Albert
N1 - Funding Information:
We are indebted to the medical and technical staff members of the computed tomography and the catheterization laboratories for their invaluable contribution and in particular to Mrs C. Schwarzer, U. Lang, and B. Child (all radiographers) for their expert technical assistance. This trial was supported by grants from Deutsches Herz-zentrum, Munich, Germany (KKF 37–02). The funding source had no role in the study design, data collection and analysis, data interpretation, writing of the report, or decision to publish the findings.
PY - 2007/12
Y1 - 2007/12
N2 - Background: Non-invasive coronary angiography by multislice spiral computed tomography (MSCT) is a promising method for the diagnosis of coronary artery disease (CAD). However, the clinical role of this method has not been established for specific patient cohorts. Therefore, the objective of the current prospective, blinded study was to investigate the diagnostic value of coronary MSCT angiography in patients with an intermediate pre-test probability for having CAD when compared with invasive angiography. Methods and results: A total of 243 patients with an intermediate pre-test probability for having CAD were asked to undergo coronary 16- or 64-slice CT angiography before planned invasive angiography from 12 September 2003 to 13 July 2005. The primary end point was defined as the diagnostic accuracy in the detection of significant coronary stenosis (≥50% lumen diameter reduction) on a per-patient and an 'intention-to-diagnose'-based analysis. Secondary end points comprised per-artery and per segment-based analyses as well as the comparison of diagnostic accuracy of 16- vs. 64-slice MSCT angiography. Of 243 enrolled patients, 129 and 114 patients were studied by 16- and 64-slice CT angiography, respectively. The overall sensitivity, negative predictive value, and specificity for CAD detection by MSCT were 99% (95% CI, 94-99%), 99% (95% CI, 94-99%), and 75% (95% CI, 67-82%), respectively. On a per-segment basis, the use of 64-slice CT was associated with significantly less inconclusive segments (7.4 vs. 11.3%, P < 0.01), resulting in a trend to an improved specificity (92 vs. 88%, P = 0.09).Conclusion: In patients with an intermediate pre-test probability for having CAD this large, prospective trial demonstrates that non-invasive coronary CT angiography is a very sensitive method for CAD detection. Furthermore, this method allows ruling out CAD very reliably and safely. Finally, 64-slice CT appears to be superior for CAD detection when compared with 16-slice CT.
AB - Background: Non-invasive coronary angiography by multislice spiral computed tomography (MSCT) is a promising method for the diagnosis of coronary artery disease (CAD). However, the clinical role of this method has not been established for specific patient cohorts. Therefore, the objective of the current prospective, blinded study was to investigate the diagnostic value of coronary MSCT angiography in patients with an intermediate pre-test probability for having CAD when compared with invasive angiography. Methods and results: A total of 243 patients with an intermediate pre-test probability for having CAD were asked to undergo coronary 16- or 64-slice CT angiography before planned invasive angiography from 12 September 2003 to 13 July 2005. The primary end point was defined as the diagnostic accuracy in the detection of significant coronary stenosis (≥50% lumen diameter reduction) on a per-patient and an 'intention-to-diagnose'-based analysis. Secondary end points comprised per-artery and per segment-based analyses as well as the comparison of diagnostic accuracy of 16- vs. 64-slice MSCT angiography. Of 243 enrolled patients, 129 and 114 patients were studied by 16- and 64-slice CT angiography, respectively. The overall sensitivity, negative predictive value, and specificity for CAD detection by MSCT were 99% (95% CI, 94-99%), 99% (95% CI, 94-99%), and 75% (95% CI, 67-82%), respectively. On a per-segment basis, the use of 64-slice CT was associated with significantly less inconclusive segments (7.4 vs. 11.3%, P < 0.01), resulting in a trend to an improved specificity (92 vs. 88%, P = 0.09).Conclusion: In patients with an intermediate pre-test probability for having CAD this large, prospective trial demonstrates that non-invasive coronary CT angiography is a very sensitive method for CAD detection. Furthermore, this method allows ruling out CAD very reliably and safely. Finally, 64-slice CT appears to be superior for CAD detection when compared with 16-slice CT.
KW - Computed tomography
KW - Coronary artery disease
KW - Sensitivity and specificity
UR - http://www.scopus.com/inward/record.url?scp=37149045276&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehm150
DO - 10.1093/eurheartj/ehm150
M3 - Article
C2 - 17540851
AN - SCOPUS:37149045276
SN - 0195-668X
VL - 28
SP - 3034
EP - 3041
JO - European Heart Journal
JF - European Heart Journal
IS - 24
ER -