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      ACCURACY OF CT ANGIOGRAPHY AND SPECT MYOCARDIAL PERFUSION IMAGING FOR THE DIAGNOSIS OF CORONARY ARTERY DISEASE

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          Abstract

          Background—

          Establishing the diagnosis of coronary artery disease (CAD) in symptomatic patients allows appropriately allocating preventative measures. Nuclear myocardial perfusion imaging (SPECT-MPI) is frequently utilized for the evaluation of CAD but coronary CT angiography (CTA) has emerged as a valid alternative.

          Methods and Results—

          We compared the accuracy of SPECT-MPI and CTA for the diagnosis of CAD in 391 symptomatic patients who were prospectively enrolled in a multicenter study after clinical referral for cardiac catheterization. Area under the receiver-operating-characteristic curve (AUC) was used to evaluate the diagnostic accuracy of CTA and SPECT-MPI for identifying patients with CAD defined as presence of ≥1 coronary artery with ≥50% lumen stenosis by quantitative coronary angiography.

          Sensitivity to identify patients with CAD was greater for CTA than SPECT-MPI (0.92 vs. 0.62, respectively, p<0.001), resulting in greater overall accuracy (AUC 0.91 [95% confidence interval 0.88–0.94]) vs. (0.69 [0.64–0.74], p< 0.001). Results were similar in patients without prior history of CAD (AUC 0.92 [0.89–0.96] vs. 0.67 [0.61–0.73], p< 0.001), and also for the secondary endpoints of ≥70% stenosis and multivessel disease, as well as subgroups, except for patients with calcium score ≥400 and those with ‘high risk’ anatomy in whom overall accuracy was similar because CTA’s superior sensitivity was offset by lower specificity in these settings. Radiation doses were 3.9 mSv for CTA and 9.8 for SPECT-MPI (p<0.001).

          Conclusions—

          CT angiography is more accurate than SPECT-MPI for the diagnosis of CAD as defined by conventional angiography and may be underutilized for this purpose in symptomatic patients.

          Clinical Trial Registration—

          URL: http://www.clinicaltrials.gov. Unique identifier: [Related object:]NCT00934037.

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          Author and article information

          Journal
          101479935
          36052
          Circ Cardiovasc Imaging
          Circ Cardiovasc Imaging
          Circulation. Cardiovascular imaging
          1941-9651
          1942-0080
          26 June 2019
          October 2015
          02 July 2019
          : 8
          : 10
          : e003533
          Affiliations
          [1 ]Division of Cardiology, Johns Hopkins University, Baltimore, MD
          [2 ]Division of Cardiology, Brigham & Women’s Hospital, Harvard University, Boston, MA
          [3 ]National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
          [4 ]Department of Radiology, Charité, Berlin, Germany
          [5 ]Division of Cardiology, St. Luke’s Hospital, Tokyo, Japan
          [6 ]Department of Epidemiology, Johns Hopkins University, Baltimore, MD
          [7 ]Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA
          [8 ]Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Brazil
          Author notes
          Correspondence to: Marcelo F. Di Carli, MD, Brigham and Women’s Hospital, ASB L1-037C, 75 Francis St, Boston, MA 02115, Phone: (617) 732-6291 Fax: (617) 582-6056
          Article
          PMC6604852 PMC6604852 6604852 nihpa1531849
          10.1161/CIRCIMAGING.115.003533
          6604852
          26467105
          27edd1fa-864e-4e5d-baf5-b21a151a530a
          History
          Categories
          Article

          cardiac computed tomography,CT angiography,myocardial ischemia,nuclear stress testing,coronary artery disease

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