Abstract
We aimed to determine the diagnostic yield and accuracy of coronary CT angiography (CCTA) in patients referred for invasive coronary angiography (ICA) based on clinical concern for coronary artery disease (CAD) and an abnormal nuclear stress myocardial perfusion imaging (MPI) study. We enrolled 100 patients (84 male, mean age 59.6 ± 8.9 years) with an abnormal MPI study and subsequent referral for ICA. Each patient underwent CCTA prior to ICA. We analyzed the prevalence of potentially obstructive CAD (≥50% stenosis) on CCTA and calculated the diagnostic accuracy of ≥50% stenosis on CCTA for the detection of clinically significant CAD on ICA (defined as any ≥70% stenosis or ≥50% left main stenosis). On CCTA, 54 patients had at least one ≥50% stenosis. With ICA, 45 patients demonstrated clinically significant CAD. A positive CCTA had 100% sensitivity and 84% specificity with a 100% negative predictive value and 83% positive predictive value for clinically significant CAD on a per patient basis in MPI positive symptomatic patients. In conclusion, almost half (48%) of patients with suspected CAD and an abnormal MPI study demonstrate no obstructive CAD on CCTA.
Highlights
Patients with clinical symptoms concerning for angina commonly undergo myocardial perfusion imaging (MPI)
We tested the hypothesis of whether using coronary CT angiography (CCTA) as a gatekeeper to invasive coronary angiography (ICA) in the setting of an abnormal MPI could reduce the number of ICAs by reliably identifying false positive studies and improve patient safety while maintaining diagnostic accuracy
Part of this rationale is that there is limited data available in patients presenting with both symptoms suggestive of coronary artery disease (CAD) and who have subsequently had an abnormal MPI leading to a referral for ICA
Summary
Patients with clinical symptoms concerning for angina commonly undergo myocardial perfusion imaging (MPI). Abnormal results deemed significant are typically referred for invasive coronary angiography (ICA) One concern of this approach is that the overall diagnostic yield of finding obstructive coronary artery disease (CAD) in patients undergoing elective ICA in patients can be relatively low, with a range of diagnostic yields which can be as high as 60% of patients demonstrating no obstructive CAD1. Part of this rationale is that there is limited data available in patients presenting with both symptoms suggestive of CAD and who have subsequently had an abnormal MPI leading to a referral for ICA. We studied the diagnostic yield and accuracy of CCTA in patients already referred for ICA based on clinical indications suggesting obstructive CAD after an abnormal MPI stress test
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