Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification: The CORE320 study

Ravi K. Sharma, Armin Zadeh, Satoru Kishi, Marcus Y. Chen, Tiago A. Magalhães, Richard T. George, Marc Dewey, Frank J. Rybicki, Klaus F. Kofoed, Albert De Roos, Swee Yaw Tan, Matthew Matheson, Andrea Vavere, Christopher Cox, Melvin E. Clouse, Julie M Miller, Jeffrey A Brinker, Andrew E. Arai, Marcelo F. Di Carli, Carlos E. RochitteJoao Lima

Research output: Contribution to journalArticle

Abstract

Background Myocardial CT perfusion (CTP) has been validated as an incremental diagnostic predictor over coronary computed tomography angiography (CTA) in assessing hemodynamically significant stenosis. Objectives To assess the diagnostic performance of CTA and CTP alone versus combined CTA-CTP stratified by Morise's pre-test probability and coronary artery calcium (CAC, Agatston) score. Methods 381 individuals (153 low/intermediate-risk for CAD, 83 high-risk, 145 known CAD) were further stratified based on CAC score cut-offs of 1-399 and ≥ 400. Area under the curve for receiver operating characteristics (AUC) was calculated to assess the diagnostic performance. Reference standards were QCA ≥ 50% stenosis + corresponding SPECT summed stress score ≥ 1. Results In both pre-test risk groups with an Agatston score of 1-399, AUCs of CTA-CTP were not significantly different than that from CTA alone. In the low/intermediate-risk group with CAC score 1-399, AUC for CTA-CTP (89) was higher than that for CTP (76, p = 0.003) alone. In the same group with CAC score ≥ 400, AUCs were higher for CTA-CTP (97) than that for CTA (88, p = 0.030) and CTP (83, p = 0.033). In high risk/known CAD patients with CAC 1-399, diagnostic performance for CTA-CTP (77) was superior to CTP (71, p = 0.037) alone. In the high risk/known CAD group with CAC score ≥ 400, AUCs for combined imaging were higher (86) than that for CTA (75, p <0.001) as well as CTP (78, p = 0.020). Conclusions The incremental diagnostic accuracy of CTP over CTA persists in patients across severity spectra of pre-test probability of CAD and coronary artery calcification. In patients with severe coronary calcification (CAC score ≥ 400), combined CTA-CTP has better diagnostic accuracy than CTA and CTP alone.

Original languageEnglish (US)
Pages (from-to)570-577
Number of pages8
JournalInternational Journal of Cardiology
Volume201
DOIs
StatePublished - Oct 10 2015

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Myocardial Perfusion Imaging
Coronary Angiography
Coronary Artery Disease
Coronary Vessels
Perfusion
Tomography
Area Under Curve
Computed Tomography Angiography
Pathologic Constriction
Single-Photon Emission-Computed Tomography
ROC Curve

Keywords

  • Abbreviations CTA coronary computed tomography angiography
  • CAC coronary artery calcium
  • CAD coronary artery disease
  • CTP myocardial computed tomography perfusion
  • ICA invasive coronary angiography
  • SSS summed stress score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification : The CORE320 study. / Sharma, Ravi K.; Zadeh, Armin; Kishi, Satoru; Chen, Marcus Y.; Magalhães, Tiago A.; George, Richard T.; Dewey, Marc; Rybicki, Frank J.; Kofoed, Klaus F.; De Roos, Albert; Tan, Swee Yaw; Matheson, Matthew; Vavere, Andrea; Cox, Christopher; Clouse, Melvin E.; Miller, Julie M; Brinker, Jeffrey A; Arai, Andrew E.; Di Carli, Marcelo F.; Rochitte, Carlos E.; Lima, Joao.

In: International Journal of Cardiology, Vol. 201, 10.10.2015, p. 570-577.

Research output: Contribution to journalArticle

Sharma, Ravi K. ; Zadeh, Armin ; Kishi, Satoru ; Chen, Marcus Y. ; Magalhães, Tiago A. ; George, Richard T. ; Dewey, Marc ; Rybicki, Frank J. ; Kofoed, Klaus F. ; De Roos, Albert ; Tan, Swee Yaw ; Matheson, Matthew ; Vavere, Andrea ; Cox, Christopher ; Clouse, Melvin E. ; Miller, Julie M ; Brinker, Jeffrey A ; Arai, Andrew E. ; Di Carli, Marcelo F. ; Rochitte, Carlos E. ; Lima, Joao. / Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification : The CORE320 study. In: International Journal of Cardiology. 2015 ; Vol. 201. pp. 570-577.
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title = "Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification: The CORE320 study",
abstract = "Background Myocardial CT perfusion (CTP) has been validated as an incremental diagnostic predictor over coronary computed tomography angiography (CTA) in assessing hemodynamically significant stenosis. Objectives To assess the diagnostic performance of CTA and CTP alone versus combined CTA-CTP stratified by Morise's pre-test probability and coronary artery calcium (CAC, Agatston) score. Methods 381 individuals (153 low/intermediate-risk for CAD, 83 high-risk, 145 known CAD) were further stratified based on CAC score cut-offs of 1-399 and ≥ 400. Area under the curve for receiver operating characteristics (AUC) was calculated to assess the diagnostic performance. Reference standards were QCA ≥ 50{\%} stenosis + corresponding SPECT summed stress score ≥ 1. Results In both pre-test risk groups with an Agatston score of 1-399, AUCs of CTA-CTP were not significantly different than that from CTA alone. In the low/intermediate-risk group with CAC score 1-399, AUC for CTA-CTP (89) was higher than that for CTP (76, p = 0.003) alone. In the same group with CAC score ≥ 400, AUCs were higher for CTA-CTP (97) than that for CTA (88, p = 0.030) and CTP (83, p = 0.033). In high risk/known CAD patients with CAC 1-399, diagnostic performance for CTA-CTP (77) was superior to CTP (71, p = 0.037) alone. In the high risk/known CAD group with CAC score ≥ 400, AUCs for combined imaging were higher (86) than that for CTA (75, p <0.001) as well as CTP (78, p = 0.020). Conclusions The incremental diagnostic accuracy of CTP over CTA persists in patients across severity spectra of pre-test probability of CAD and coronary artery calcification. In patients with severe coronary calcification (CAC score ≥ 400), combined CTA-CTP has better diagnostic accuracy than CTA and CTP alone.",
keywords = "Abbreviations CTA coronary computed tomography angiography, CAC coronary artery calcium, CAD coronary artery disease, CTP myocardial computed tomography perfusion, ICA invasive coronary angiography, SSS summed stress score",
author = "Sharma, {Ravi K.} and Armin Zadeh and Satoru Kishi and Chen, {Marcus Y.} and Magalh{\~a}es, {Tiago A.} and George, {Richard T.} and Marc Dewey and Rybicki, {Frank J.} and Kofoed, {Klaus F.} and {De Roos}, Albert and Tan, {Swee Yaw} and Matthew Matheson and Andrea Vavere and Christopher Cox and Clouse, {Melvin E.} and Miller, {Julie M} and Brinker, {Jeffrey A} and Arai, {Andrew E.} and {Di Carli}, {Marcelo F.} and Rochitte, {Carlos E.} and Joao Lima",
year = "2015",
month = "10",
day = "10",
doi = "10.1016/j.ijcard.2015.05.110",
language = "English (US)",
volume = "201",
pages = "570--577",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification

T2 - The CORE320 study

AU - Sharma, Ravi K.

AU - Zadeh, Armin

AU - Kishi, Satoru

AU - Chen, Marcus Y.

AU - Magalhães, Tiago A.

AU - George, Richard T.

AU - Dewey, Marc

AU - Rybicki, Frank J.

AU - Kofoed, Klaus F.

AU - De Roos, Albert

AU - Tan, Swee Yaw

AU - Matheson, Matthew

AU - Vavere, Andrea

AU - Cox, Christopher

AU - Clouse, Melvin E.

AU - Miller, Julie M

AU - Brinker, Jeffrey A

AU - Arai, Andrew E.

AU - Di Carli, Marcelo F.

AU - Rochitte, Carlos E.

AU - Lima, Joao

PY - 2015/10/10

Y1 - 2015/10/10

N2 - Background Myocardial CT perfusion (CTP) has been validated as an incremental diagnostic predictor over coronary computed tomography angiography (CTA) in assessing hemodynamically significant stenosis. Objectives To assess the diagnostic performance of CTA and CTP alone versus combined CTA-CTP stratified by Morise's pre-test probability and coronary artery calcium (CAC, Agatston) score. Methods 381 individuals (153 low/intermediate-risk for CAD, 83 high-risk, 145 known CAD) were further stratified based on CAC score cut-offs of 1-399 and ≥ 400. Area under the curve for receiver operating characteristics (AUC) was calculated to assess the diagnostic performance. Reference standards were QCA ≥ 50% stenosis + corresponding SPECT summed stress score ≥ 1. Results In both pre-test risk groups with an Agatston score of 1-399, AUCs of CTA-CTP were not significantly different than that from CTA alone. In the low/intermediate-risk group with CAC score 1-399, AUC for CTA-CTP (89) was higher than that for CTP (76, p = 0.003) alone. In the same group with CAC score ≥ 400, AUCs were higher for CTA-CTP (97) than that for CTA (88, p = 0.030) and CTP (83, p = 0.033). In high risk/known CAD patients with CAC 1-399, diagnostic performance for CTA-CTP (77) was superior to CTP (71, p = 0.037) alone. In the high risk/known CAD group with CAC score ≥ 400, AUCs for combined imaging were higher (86) than that for CTA (75, p <0.001) as well as CTP (78, p = 0.020). Conclusions The incremental diagnostic accuracy of CTP over CTA persists in patients across severity spectra of pre-test probability of CAD and coronary artery calcification. In patients with severe coronary calcification (CAC score ≥ 400), combined CTA-CTP has better diagnostic accuracy than CTA and CTP alone.

AB - Background Myocardial CT perfusion (CTP) has been validated as an incremental diagnostic predictor over coronary computed tomography angiography (CTA) in assessing hemodynamically significant stenosis. Objectives To assess the diagnostic performance of CTA and CTP alone versus combined CTA-CTP stratified by Morise's pre-test probability and coronary artery calcium (CAC, Agatston) score. Methods 381 individuals (153 low/intermediate-risk for CAD, 83 high-risk, 145 known CAD) were further stratified based on CAC score cut-offs of 1-399 and ≥ 400. Area under the curve for receiver operating characteristics (AUC) was calculated to assess the diagnostic performance. Reference standards were QCA ≥ 50% stenosis + corresponding SPECT summed stress score ≥ 1. Results In both pre-test risk groups with an Agatston score of 1-399, AUCs of CTA-CTP were not significantly different than that from CTA alone. In the low/intermediate-risk group with CAC score 1-399, AUC for CTA-CTP (89) was higher than that for CTP (76, p = 0.003) alone. In the same group with CAC score ≥ 400, AUCs were higher for CTA-CTP (97) than that for CTA (88, p = 0.030) and CTP (83, p = 0.033). In high risk/known CAD patients with CAC 1-399, diagnostic performance for CTA-CTP (77) was superior to CTP (71, p = 0.037) alone. In the high risk/known CAD group with CAC score ≥ 400, AUCs for combined imaging were higher (86) than that for CTA (75, p <0.001) as well as CTP (78, p = 0.020). Conclusions The incremental diagnostic accuracy of CTP over CTA persists in patients across severity spectra of pre-test probability of CAD and coronary artery calcification. In patients with severe coronary calcification (CAC score ≥ 400), combined CTA-CTP has better diagnostic accuracy than CTA and CTP alone.

KW - Abbreviations CTA coronary computed tomography angiography

KW - CAC coronary artery calcium

KW - CAD coronary artery disease

KW - CTP myocardial computed tomography perfusion

KW - ICA invasive coronary angiography

KW - SSS summed stress score

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U2 - 10.1016/j.ijcard.2015.05.110

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JO - International Journal of Cardiology

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