JACC: CCTA proves effective as noninvasive alternative to angiography

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In chest pain patients without known coronary artery disease, 64-multidetector coronary CT angiography (CCTA) possesses higher diagnostic accuracy for detection of obstructive coronary stenosis than invasive coronary angiography (ICA), according to research published online Aug. 22 in the Journal of the American College of Cardiology (JACC).

Matthew J. Budoff, MD, a principal investigator at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed), and a lead author of the study, and colleagues prospectively evaluated subjects with chest pain who were clinically referred for ICA at 16 sites.

CCTAs were scored by consensus of three independent blinded readers. The ICAs were evaluated for coronary stenosis based on quantitative coronary angiography (QCA). No subjects were excluded for baseline coronary artery calcium score or body mass index.

A total of 230 subjects underwent both CCTA and ICA. On a patient-based model, the sensitivity, specificity and positive and negative predictive values to detect 50 percent or 70 percent stenosis were 95 percent, 83 percent, 64 percent and 99 percent, respectively, and 94 percent, 83 percent, 48 percent and 99 percent, respectively, the authors wrote.

The results revealed electrocardiographically gated 64-multidetector CCTA “possesses high diagnostic accuracy for detection of obstructive coronary stenosis at both thresholds of 50 percent and 70 percent stenosis. More importantly, the 99 percent negative predictive value at the patient and vessel levels establishes CCTA as an effective noninvasive alternative to ICA to rule out obstructive coronary artery stenosis,” according to the researchers.

"The research found this noninvasive method of cardiac imaging will effectively detect stenosis of the coronary arteries," Budoff said. "This is good news for patients who, in the past, might have been forced to undergo a more expensive and invasive procedure to determine if they suffered from blockages in the arteries leading to their hearts."

GE Healthcare funded the study, "Diagnostic Performance of 64-Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease,” and provided cardiac CT imaging systems used in the study. Budoff and James K. Min, MD, who also participated in the study, are on the Speakers' Bureau for General Electric.