Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: registry data in NSTEMI acute coronary syndrome and influence of gender and risk factors

E Maffei, C Martini, C Tedeschi, P Spagnolo, A Zuccarelli, T Arcadi, A Guaricci, S Seitun, A.C. Weustink, Nico Mollet, F. Cademartiri

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Abstract

Purpose. This study sought to evaluate the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (a parts per thousand yen50% lumen reduction) compared with conventional coronary angiography (CAG) in non-ST-elevation myocardial infarction-acute coronary syndrome (NSTEMI-ACS) and in subgroups selected by gender and number of risk factors (RF). Material and methods. We selected from a population of 1,500 patients in a multicentre registry with NSTEMI-ACS who had undergone CTCA and CAG, (n=237; 187 men, mean age 63 +/- 10 years). Diagnostic accuracy and likelihood ratios (LR) of CTCA were assessed against CAG in the total population and subgroups (men, women: 0 RF = absence of RF, 1-2 RF = presence of one or two RF, > 2 RF = presence of more than two RF). Results. The prevalence of obstructive disease was 53%. In the per-patient analysis, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CTCA were 100% (men 100%; women 100%; 0 RF 100%; 1-2 RF 100%; > 2 RF 100%), 95% (men 98%; women 50%; 0 RF NA% (NA, not assessable); 1-2 RF 96%; > 2 RF 96%), 95% (men 98%; women 91%; 0 RF 91%; 1-2 RF 96%; > 2 RF 96%), 100% (men 100%; women 100%; 0 RF NV%; 1-2 RF 100%; > 2 RF 100%), respectively. The per-segment analysis showed a reduction in PPV (ranging between 56% and 67%). The per-patient LR+ ranged between 18 and 27, whereas LR-were always 0. We observed no significant differences in diagnostic accuracy between subgroups. Conclusions. CTCA is a reliable diagnostic modality with high sensitivity and NPV in NSTEMI-ACS patients who are not candidates for early revascularisation, regardless of gender and number of risk factors.
Original languageUndefined/Unknown
Pages (from-to)1000-1013
Number of pages14
JournalRadiologia Medica
Volume116
Issue number7
DOIs
Publication statusPublished - 2011

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  • EMC COEUR-09

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