Accuracy of multidetector computed tomography for detection of coronary artery stenosis in acute coronary syndrome compared with stable coronary disease: a CORE64 multicenter trial substudy.

Leonardo Sara, Carlos E Rochitte, Pedro A Lemos, Hiroyuki Niinuma, Marc Dewey, Edward P Shapiro, Ilan Gottlieb, Antônio P Mansur, José C Nicolau, Albert C Lardo, Clerio F Azevedo, Roberto Kalil-Filho, Andrea L Vavere, Silvia Cohn, Christopher Cox, Jeffrey Brinker, Julie M Miller, João A C Lima

Journal: International journal of cardiology 2015;177(2):385-91

PMID: 25281436

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Multi-detector computed tomography angiography (MDCTA) is a promising method for risk assessment of patients with acute chest pain. However, its diagnostic performance in higher-risk patients has not been investigated in a large international multicenter trial. Therefore, in the present study we sought to estimate the diagnostic accuracy of MDCTA to detect significant coronary stenosis in patients with acute coronary syndrome (ACS).

METHODS

Patients included in the CORE64 study were categorized as suspected-ACS or non-ACS based on clinical data. A 64-row coronary MDCTA was performed before invasive coronary angiography (ICA) and both exams were evaluated by blinded, independent core laboratories.

RESULTS

From 371 patients included, 94 were categorized as suspected ACS and 277 as non-ACS. Patient-based analysis showed an area under the receiver-operating-characteristic curve (AUC) for detecting ≥ 50% coronary stenosis of 0.95 (95% CI: 0.88-0.98) in ACS and 0.92 (95% CI: 0.88-0.95) in non-ACS group (P=0.29). The sensitivity, specificity, positive and negative predictive values of MDCTA were 0.90(0.80-0.96), 0.88(0.70-0.98), 0.95(0.87-0.99) and 0.77(0.58-0.90) in suspected ACS patients and 0.87(0.81-0.92), 0.86(0.79-0.92), 0.91(0.85-0.95) and 0.82(0.74-0.89) in non-ACS patients (P NS for all comparisons). The mean calcium scores (CS) were 282 ± 449 in suspected ACS and 435 ± 668 in non-ACS group. The accuracy of CS to detect significant coronary stenosis was only moderate and the absence or minimal coronary artery calcification could not exclude the presence of significant coronary stenosis, particularly in ACS patients.

CONCLUSIONS

The diagnostic accuracy of MDCTA to detect significant coronary stenosis is high and comparable for both ACS and non-ACS patients.

Address: Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil.; Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: [email protected].; Iwate Medical University, Morioka, Japan.; Charité Medical School, Humboldt-Universität zu Berlin and Freie Universität zu Berlin, Berlin.; Johns Hopkins University School of Medicine, Baltimore, MD, United States.; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.

DOI: 10.1016/j.ijcard.2014.08.130

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MeSH Terms: Acute Coronary Syndrome, Aged, Coronary Artery Disease, Coronary Stenosis, Female, Humans, Internationality, Male, Middle Aged, Multidetector Computed Tomography, Prospective Studies