Abstract P107: Diagnostic Accuracy of Coronary Artery Stenosis With 64-Multidetector Row Coronary Computed Tomographic Angiography in Veteran Patients Presenting With Chest Pain

Abstract

Background: The ACCURACY trial was a prospective multicenter study using 64-multidetector row coronary computed tomographic angiography (CCTA) to evaluate its diagnostic performance for the detection and exclusion of coronary artery stenosis in patients presenting with chest pain without known coronary artery disease (CAD). We evaluated patients at a Veterans Administration Hospital (VAH) to assess if CCTA possesses high diagnostic accuracy for detection of obstructive CAD at both thresholds of 50% and 70% stenosis compared to invasive coronary angiography (ICA). Methods: We conducted a retrospective study of 44 patients at a VAH from November 2008 to November 2009. Baseline demographics are noted in Table 1 . Inclusion criteria were: age ≥ 21, no known history of CAD, and symptoms of typical or atypical chest pain. All patients underwent CCTA and subsequently had ICA performed within 1 month. CCTAs and ICAs were evaluated and scored for coronary stenosis by 2 independent blinded readers. A vessel based analysis was used to evaluate for ≥ 50% and ≥ 70% stenosis using a 15 segment American Heart Association coronary tree model. Results: A total of 176 vessels were analyzed. Compared to ICA, CCTA's sensitivity, specificity, positive predictive value, and negative predictive value (NPV) for detecting greater than 50% stenoses were, 85%, 89%, 54% and 98%, respectively, and 86%, 91%, 51%, 98%, respectively, for stenoses greater than 70%. There were no statistically significant differences for sensitivity, specificity or NPV compared to the findings in the ACCURACY trial. Conclusion: Among veteran patients presenting with chest pain and no prior history of CAD, CCTA appears to be an effective noninvasive alternative to exclude coronary artery stenosis. Table 1: Baseline Demographics Risk Factors ACCURACY Trial VHA patients p-value Age 57 ± 10 61 ± 9.9 0.016 Sex Male gender 59% 95% p < 0.001 Race Caucasian African American Hispanic Other 87.8% 5.7% 3.5% 3.1% 86% 6.3% 3.8% 3.9% NS Body mass index (kg/m²) 31.4 ± 6.2 29.9 ± 6.1 NS Heart rate (beats/min) 60 ± 12 63.2 ± 9.2 NS Creatinine (mg/dl) 1.0 ± 0.2 0.97 ± 0.19 NS Agatston coronary artery calcium score 284 ± 538 916 ± 805 p < 0.001 Diabetes 23.9% 21.6% NS Hypertension 67% 64% NS Hyperlipidemia 68.3% 66% NS Family History of coronary artery disease 73.5% 71.2% NS Smoker 55.7% 53.2% NS