What is the accuracy of coronary computed tomography angiography (CCTA) in coronary artery disease (CAD)?

Updated: Dec 21, 2017
  • Author: Eugene C Lin, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

The majority of studies (with the exception of the Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors [CORE 64] study) indicate that a negative CCTA can effectively rule out obstructive coronary artery disease. In a 2008 meta-analysis, [21] 64-slice CCTA had a sensitivity of 99% and negative predictive value (NPV) of 100% for patient-based detection of significant CAD. However the specificity has been lower than the sensitivity in most studies, and false-positive results are possible, particularly in patients with high calcium scores.

In the Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography (ACCURACY) prospective multicenter trial of patients with chest pain without known CAD and intermediate disease prevalence, 64-slice CCTA had a patient-based sensitivity of 94% and a specificity of 83% in detecting stenosis of 70% or greater (comparable values were seen at a 50% stenosis level). Patients with high calcium scores were not excluded from the study. Calcium scores greater than 400 reduced specificity significantly. The NPV of CCTA was 99%. [12]

In the CORE trial, 64 prospective multicenter trial of patients with suspected symptomatic CAD referred for conventional coronary angiography, 64-slice CCTA had a patient–based sensitivity of 85% and specificity of 90% (excluding patients with a calcium score greater than 600) for detecting stenoses 50% or greater. However, the NPV of 83% in this study was lower than in other studies. [25]

In a 2008 meta-analysis, the sensitivity was highest in the left main artery and lowest (85%) in the circumflex artery. [21]

In a systematic review that evaluated the diagnostic accuracy of CCTA for detecting cardiac allograft vasculopathy (CAV) compared with conventional coronary angiography (CCAG) alone or with intravascular ultrasound (IVUS), Wever-Pinzon et al found that CCTA had high sensitivity, specificity, and NPV for the detection of any CAV and significant CAV. [26] When 64-slice was compared with 16-slice CCTA, a trend toward improved sensitivity and NPV for identifying significant CAV was noted.

The ACCURACY trial suggested that, compared with other noninvasive modalities such as stress echocardiography and stress nuclear testing, CCTA has comparable specificity but superior sensitivity and NPV. [12]


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