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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)385-391
Number of pages7
JournalInternational Journal of Cardiology
Volume177
Issue number2
DOIs
StatePublished - Dec 15 2014

Keywords

  • Acute coronary syndrome
  • Angiography
  • Multi-detector computed tomography angiography
  • Tomography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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