Accuracy of Computed Tomographic Angiography and Single-Photon Emission Computed Tomography–Acquired Myocardial Perfusion Imaging for the Diagnosis of Coronary Artery Disease

Content Provider	Scilit
Author	Arbab-Zadeh, Armin Carli, Marcelo F. Di Cerci, Rodrigo George, Richard T. Chen, Marcus Y. Dewey, Marc Niinuma, Hiroyuki Vavere, Andrea L. Betoko, Aisha Plotkin, Michail Cox, Christopher Clouse, Melvin E. Arai, Andrew E. Rochitte, Carlos E. Lima, Joao A. C. Brinker, Jeffrey Miller, Julie M.
Copyright Year	2015
Description	Journal: Circulation: Cardiovascular Imaging Background—: Establishing the diagnosis of coronary artery disease (CAD) in symptomatic patients allows appropriately allocating preventative measures. Single-photon emission computed tomography (CT)–acquired myocardial perfusion imaging (SPECT-MPI) is frequently used 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. The area under the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of CTA and SPECT-MPI for identifying patients with CAD defined as the 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 versus 0.62, respectively; P <0.001), resulting in greater overall accuracy (area under the receiver operating characteristic curve, 0.91 [95% confidence interval, 0.88–0.94] versus 0.69 [0.64–0.74]; P <0.001). Results were similar in patients without previous history of CAD (area under the receiver operating characteristic curve, 0.92 [0.89–0.96] versus 0.67 [0.61–0.73]; P <0.001) and also for the secondary end points of ≥70% stenosis and multivessel disease, as well as subgroups, except for patients with a calcium score of ≥400 and those with high-risk anatomy in whom the 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—: CTA is more accurate than SPECT-MPI for the diagnosis of CAD as defined by conventional angiography and may be underused for this purpose in symptomatic patients. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00934037.
Related Links	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604852/pdf https://www.ahajournals.org/doi/pdf/10.1161/CIRCIMAGING.115.003533
Ending Page	e003533
Page Count	1
Starting Page	e003533
ISSN	19419651
e-ISSN	19420080
DOI	10.1161/circimaging.115.003533
Journal	Circulation: Cardiovascular Imaging
Issue Number	10
Volume Number	8
Language	English
Publisher	Ovid Technologies (Wolters Kluwer Health)
Publisher Date	2015-10-01
Access Restriction	Open
Subject Keyword	Journal: Circulation: Cardiovascular Imaging Peripheral Vascular Disease Myocardial Ischemia Coronary Angiography Myocardial Perfusion Imaging Roc Curve Coronary Artery Disease
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Cardiology and Cardiovascular Medicine