Prognostic Value of Multidetector Coronary CT Angiography for Prediction
Prognostic Value of Multidetector Coronary CT Angiography for Prediction
Recent innovations in multidetector coronary computed tomographic angiography (CCTA) have transformed computed tomography (CT) from a transaxial-restricted two-dimensional imaging method to a true three-dimensional modality. With the latest introduction of new generation CT scanners that combine submillimeter spatial resolution, subsecond gantry rotation, and rapid volume coverage, accurate virtually artifact-free noninvasive imaging of the coronary arteries is now possible with true isotropic resolution.
Prior studies of multidetector (also known as multislice) CCTA have focused primarily on its diagnostic accuracy to detect obstructive coronary artery stenosis, generally using invasive coronary angiography as the reference standard. In a recent meta-analysis of 27 studies encompassing more than 22,000 coronary artery segments, Hamon et al. found the per-segment diagnostic sensitivity and specificity of CCTA to be 81% (95% confidence interval [CI], 72-89%) and 93% (95% CI, 90-97%), respectively.
In a per-patient analysis of CCTA to detect obstructive coronary artery stenosis, the Hamon paper showed that sensitivity was enhanced [96%; 95% CI, 94-98%] but at the cost of specificity [74%; 95% CI, 65-84%]. As in prior studies, the negative predictive accuracy of CCTA to exclude obstructive coronary artery stenosis approached 100% with a negative predictive value of 96.5% at segment level dropping to 94% at patient level. To date, however, little has been published with regards to the prognostic utility of CCTA. A new study reveals the prognostic value of CCTA findings and provides the first mortality data that may be used to guide clinical application of this technology.
Abstract
Recent innovations in multidetector coronary computed tomographic angiography (CCTA) have transformed computed tomography (CT) from a transaxial-restricted two-dimensional imaging method to a true three-dimensional modality. With the latest introduction of new generation CT scanners that combine submillimeter spatial resolution, subsecond gantry rotation, and rapid volume coverage, accurate virtually artifact-free noninvasive imaging of the coronary arteries is now possible with true isotropic resolution.
Prior studies of multidetector (also known as multislice) CCTA have focused primarily on its diagnostic accuracy to detect obstructive coronary artery stenosis, generally using invasive coronary angiography as the reference standard. In a recent meta-analysis of 27 studies encompassing more than 22,000 coronary artery segments, Hamon et al. found the per-segment diagnostic sensitivity and specificity of CCTA to be 81% (95% confidence interval [CI], 72-89%) and 93% (95% CI, 90-97%), respectively.
In a per-patient analysis of CCTA to detect obstructive coronary artery stenosis, the Hamon paper showed that sensitivity was enhanced [96%; 95% CI, 94-98%] but at the cost of specificity [74%; 95% CI, 65-84%]. As in prior studies, the negative predictive accuracy of CCTA to exclude obstructive coronary artery stenosis approached 100% with a negative predictive value of 96.5% at segment level dropping to 94% at patient level. To date, however, little has been published with regards to the prognostic utility of CCTA. A new study reveals the prognostic value of CCTA findings and provides the first mortality data that may be used to guide clinical application of this technology.