Coronary disease: Computed tomography coronary angiography for diagnosis
DISEASE INTERVENTION COMPARISON RESULTS
Eur Heart J. 2011 Mar;32(5):637-45 Diagnostic
IN coronary disease The Use of
coronary multidetector computed tomography
As Diagnostic Tool
Is worse Than
coronary angiography
To detect significant coronary stenosis: sensib 100%, spec 85%, positive predict value 81%, negative predict value 100%. It detected all patients with atherosclerosis but misclassified some as severe stenosis
JAMA. 2006 Jul 26;296(4):403-11 Diagnostic
IN coronary disease The Use of
coronary multidetector computed tomography
As Diagnostic Tool
Is worse Than
coronary angiography
To diagnose coronary stenosis of more than 50%: in patient-based analysis, 98% sensitivity for detecting at least 1 stenosis, 54% specificity, 50% positive predictive value, 99% negative predictive value. So, too much false positives.
J Am Coll Cardiol. 2010 Mar 9;55(10):1017-28 Cohorts
IN coronary disease The Use of
cardiac computed tomography angiography , and also, in addition, left ventricle ejection fraction
As Prognostic Item
Is useful Than
no comparison here
To predict increased risk of all-cause mortality or nonfatal myocardial infarction at 1.5 years: HR 3 when sever coronary disease detected.
Ann Intern Med. 2010 May 18;152(10):630-9 Cohorts
IN coronary disease, chest pain The Use of
coronary multidetector computed tomography, computed tomography coronary angiography
As Diagnostic Tool
Is better Than
stress testing
To screen for coronary disease, specially in patients at intermediate pre-test probability (+ results indicated 93% need for coronary angiography and negative results indicated no need for further testing (1% + cases).
Heart. 2010 Dec;96(24):1973-9 Diagnostic
IN coronary disease, chest pain, low to intermediate risk patients The Use of
coronary multidetector computed tomography, 64-slice CT coronary angiography
As Diagnostic Tool
Is better Than
exercise ECG testing (invasive coronariography as reference test)
To accurately diagnose significant coronary disease: sensitivity 100%, specificity 98.7%, positive and negative predictive values 92.9% and 100%, at the patient level (as opposed to analysis by coronary segment)
Health Technol Assess. 2008 May;12(17):iii-iv, ix-143 Systematic Review
IN coronary disease, clinically suspected The Use of
coronary multidetector computed tomography, 64-slice or higher
As Diagnostic Tool
Is worse Than
invasive coronary angiography
To diagnose suspected coronary disease: high negative predictive value 95 - 100%, less good positive predictive value, less detailed info. Useful to avoid unnecessary invasive angiography.
J Am Coll Cardiol. 2007 Oct 9;50(15):1469-75 Diagnostic
IN coronary disease, intermediate and low risk symptomatic patients The Use of
coronary multidetector computed tomography
As Diagnostic Tool
Is useful Than
coronary angiography as gold standard
To diagnose significant coronary disease: see below pre and post-test probabilities of coronary disease for each strata of high, intermediate and low risk.
Eur Heart J. 2007 Dec;28(24):3034-41 Diagnostic
IN coronary disease, intermediate pre-test probability patients The Use of
16 and 64-slice coronary multidetector computed tomography
As Diagnostic Tool
Is worse Than
coronary angiography as gold standard
To diagnose significant coronary disease: sensitivity 99%, specificity 75%, NPV 99%, PPV ?
J Am Coll Cardiol. 2007 Feb 27;49(8):863-71 Randomized Controlled Trial, Diagnostic
IN pain, chest, acute, ruling out coronary disease The Use of
coronary multidetector computed tomography
As Diagnostic Tool
Is better Than
standard diagnostic evaluation of low-risk acute chest pain
To exclude or identify coronary disease as the source of chest pain: scan alone immediately did it in 75% of patients and reduced time to diagnosis.
Circulation. 2006 Nov 21;114(21):2251-60. Epub 2006 Oct 30 Diagnostic
IN pain, chest, acute, ruling out coronary disease The Use of
coronary multidetector computed tomography, added to clinical estimate
As Diagnostic Tool
Is better Than
clinical estimate only
To accurately rule out an acute coronary syndrome if not significant coronary stenosis found (negative predictive value, 100%).