Detection of significant coronary artery disease by noninvasive anatomical and functional imaging
Danilo Neglia, Daniele Rovai, Chiara Caselli, Mikko Pietila, Anna Teresinska, Santiago Aguadé-Bruix, Maria Nazarena Pizzi, Giancarlo Todiere, Alessia Gimelli, Stephen Schroeder, Tanja Drosch, Rosa Poddighe, Giancarlo Casolo, Constantinos Anagnostopoulos, Francesca Pugliese, Francois Rouzet, Dominique Le Guludec, Francesco Cappelli, Serafina Valente, Gian Franco Gensini, Camilla Zawaideh, Selene Capitanio, Gianmario Sambuceti, Fabio Marsico, Pasquale Perrone Filardi, Covadonga Fernández-Golfín, Luis M Rincón, Frank P Graner, Michiel A de Graaf, Michael Fiechter, Julia Stehli, Oliver Gaemperli, Eliana Reyes, Sandy Nkomo, Maija Mäki, Valentina Lorenzoni, Giuseppe Turchetti, Clara Carpeggiani, Martina Marinelli, Stefano Puzzuoli, Maurizio Mangione, Paolo Marcheschi, Fabio Mariani, Daniela Giannessi, Stephan Nekolla, Massimo Lombardi, Rosa Sicari, Arthur J H A Scholte, José L Zamorano, Philipp A Kaufmann, S Richard Underwood, Juhani Knuuti, EVINCI Study Investigators, Danilo Neglia, Daniele Rovai, Chiara Caselli, Mikko Pietila, Anna Teresinska, Santiago Aguadé-Bruix, Maria Nazarena Pizzi, Giancarlo Todiere, Alessia Gimelli, Stephen Schroeder, Tanja Drosch, Rosa Poddighe, Giancarlo Casolo, Constantinos Anagnostopoulos, Francesca Pugliese, Francois Rouzet, Dominique Le Guludec, Francesco Cappelli, Serafina Valente, Gian Franco Gensini, Camilla Zawaideh, Selene Capitanio, Gianmario Sambuceti, Fabio Marsico, Pasquale Perrone Filardi, Covadonga Fernández-Golfín, Luis M Rincón, Frank P Graner, Michiel A de Graaf, Michael Fiechter, Julia Stehli, Oliver Gaemperli, Eliana Reyes, Sandy Nkomo, Maija Mäki, Valentina Lorenzoni, Giuseppe Turchetti, Clara Carpeggiani, Martina Marinelli, Stefano Puzzuoli, Maurizio Mangione, Paolo Marcheschi, Fabio Mariani, Daniela Giannessi, Stephan Nekolla, Massimo Lombardi, Rosa Sicari, Arthur J H A Scholte, José L Zamorano, Philipp A Kaufmann, S Richard Underwood, Juhani Knuuti, EVINCI Study Investigators
Abstract
Background: The choice of imaging techniques in patients with suspected coronary artery disease (CAD) varies between countries, regions, and hospitals. This prospective, multicenter, comparative effectiveness study was designed to assess the relative accuracy of commonly used imaging techniques for identifying patients with significant CAD.
Methods and results: A total of 475 patients with stable chest pain and intermediate likelihood of CAD underwent coronary computed tomographic angiography and stress myocardial perfusion imaging by single photon emission computed tomography or positron emission tomography, and ventricular wall motion imaging by stress echocardiography or cardiac magnetic resonance. If ≥1 test was abnormal, patients underwent invasive coronary angiography. Significant CAD was defined by invasive coronary angiography as >50% stenosis of the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70% stenosis with fractional flow reserve ≤0.8. Significant CAD was present in 29% of patients. In a patient-based analysis, coronary computed tomographic angiography had the highest diagnostic accuracy, the area under the receiver operating characteristics curve being 0.91 (95% confidence interval, 0.88-0.94), sensitivity being 91%, and specificity being 92%. Myocardial perfusion imaging had good diagnostic accuracy (area under the curve, 0.74; confidence interval, 0.69-0.78), sensitivity 74%, and specificity 73%. Wall motion imaging had similar accuracy (area under the curve, 0.70; confidence interval, 0.65-0.75) but lower sensitivity (49%, P<0.001) and higher specificity (92%, P<0.001). The diagnostic accuracy of myocardial perfusion imaging and wall motion imaging were lower than that of coronary computed tomographic angiography (P<0.001).
Conclusions: In a multicenter European population of patients with stable chest pain and low prevalence of CAD, coronary computed tomographic angiography is more accurate than noninvasive functional testing for detecting significant CAD defined invasively.
Clinical trial registration url: http://www.clinicaltrials.gov. Unique identifier: NCT00979199.
Keywords: coronary artery disease; coronary computed tomography angiography; echocardiography; magnetic resonance imaging; myocardial perfusion imaging; positron emission tomography; single photon computed emission tomography.
© 2015 American Heart Association, Inc.
Source: PubMed