Accuracy of multidetector spiral computed tomography in detecting significant coronary stenosis in patient populations with differing pre-test probabilities of disease.
TL;DR: Because of its excellent sensitivity and specificity in patients with a low pre-test likelihood of CAD, MDCT could be helpful in clinical decision-making in this population.
About: This article is published in Clinical Radiology.The article was published on 2007-10-01. It has received 38 citations till now. The article focuses on the topics: Population & Coronary artery disease.
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TL;DR: Comparisons of CT and MRI for ruling out clinically significant coronary artery disease in adults with suspected or known CAD show CT is more accurate than MRI, as do slowed heart rates.
Abstract: This meta-analysis compared the effectiveness of multislice computed tomography (CT) and magnetic resonance imaging (MRI) in ruling out clinically significant coronary artery disease (CAD) in adult...
254 citations
TL;DR: In this article, a systematic search for diagnostic accuracy studies of coronary computed tomography (CT) angiography, full texts of relevant studies were evaluated to determine whether they could calculate an alternative 3×2 table.
Abstract: Objective To determine whether a 3×2 table, using an intention to diagnose approach, is better than the “classic” 2×2 table at handling transparent reporting and non-evaluable results, when assessing the accuracy of a diagnostic test. Design Based on a systematic search for diagnostic accuracy studies of coronary computed tomography (CT) angiography, full texts of relevant studies were evaluated to determine whether they could calculate an alternative 3×2 table. To quantify an overall effect, we pooled diagnostic accuracy values according to a meta-analytical approach. Data sources Medline (via PubMed), Embase (via Ovid), and ISI Web of Science electronic databases. Eligibility criteria Prospective English or German language studies comparing coronary CT with conventional coronary angiography in all patients and providing sufficient data for a patient level analysis. Results 120 studies (10 287 patients) were eligible. Studies varied greatly in their approaches to handling non-evaluable findings. We found 26 studies (including 2298 patients) that allowed us to calculate both 2×2 tables and 3×2 tables. Using a bivariate random effects model, we compared the 2×2 table with the 3×2 table, and found significant differences for pooled sensitivity (98.2 (95% confidence interval 96.7 to 99.1) v 92.7 (88.5 to 95.3)), area under the curve (0.99 (0.98 to 1.00) v 0.93 (0.91 to 0.95)), positive likelihood ratio (9.1 (6.2 to 13.3) v 4.4 (3.3 to 6.0)), and negative likelihood ratio (0.02 (0.01 to 0.04) v 0.09 (0.06 to 0.15); (P Conclusion Parameters for diagnostic performance significantly decrease if non-evaluable results are included by a 3×2 table for analysis (intention to diagnose approach). This approach provides a more realistic picture of the clinical potential of diagnostic tests.
149 citations
TL;DR: Prospective ECG-triggering computed tomography allows an accurate detection of coronary stenosis, despite a slight reduction of diagnostic performance, with a low radiation dose.
125 citations
TL;DR: Sensitive cardiac troponin assays have high-diagnostic accuracy also in CAD patients and retain prognostic value, and Elevated levels of cTn measured with the sensitive assays predicted mortality irrespective of pre-existing CAD, age, sex, and cardiovascular risk factors.
Abstract: Aims We sought to examine the diagnostic and prognostic utility of sensitive cardiac troponin (cTn) assays in patients with pre-existing coronary artery disease (CAD).
Methods and results We conducted a multicentre study to examine the diagnostic accuracy of one high-sensitive and two sensitive cTn assays in 1098 consecutive patients presenting with symptoms suggestive of acute myocardial infarction (AMI), of whom 401 (37%) had pre-existing CAD. Measurements of Roche high-sensitive cTnT (hs-cTnT), Siemens cTnI-Ultra, Abbott-Architect cTnI and the standard assay (Roche cTnT) were performed in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists. Acute myocardial infarction was the final diagnosis in 19% of CAD patients. Among patients with diagnoses other than AMI, baseline cTn levels were elevated above the 99th percentile with Roche hs-cTnT in 40%, with Siemens TnI-Ultra in 15%, and Abbott-Architect cTnI in 13% of them. In patients with pre-existing CAD, the diagnostic accuracy at presentation, quantified by the area under the receiver operator characteristic curve (AUC), was significantly greater for the sensitive cTn assays compared with the standard assay (AUC for Roche hs-cTnT, 0.92; Siemens cTnI-Ultra, 0.94; and Abbott-Architect cTnI, 0.93 vs. AUC for the standard assay, 0.87; P < 0.01 for all comparisons). Elevated levels of cTn measured with the sensitive assays predicted mortality irrespective of pre-existing CAD, age, sex, and cardiovascular risk factors.
Conclusion Sensitive cTn assays have high-diagnostic accuracy also in CAD patients. Mild elevations are common in non-AMI patients and test-specific optimal cut-off levels tend to be higher in CAD patients than in patients without history of CAD. Sensitive cTn assays also retain prognostic value. (ClinicalTrials.gov number, [NCT00470587][1]).
[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00470587&atom=%2Fehj%2Fearly%2F2011%2F10%2F31%2Feurheartj.ehr376.atom
109 citations
TL;DR: Coronary CTA can be used to accurately predict the presence of obstructive disease in > 90% of small and moderate-sized calcified coronary artery plaques.
Abstract: OBJECTIVE. Because of beam-hardening and blooming artifacts, it is difficult to determine the degree of stenosis caused by calcified coronary artery plaques at coronary CT angiography (CTA). Our goal was to determine how accurate coronary CTA is in evaluating these lesions.MATERIALS AND METHODS. Thirty-one patients who had one or more calcified coronary artery plaques at coronary CTA underwent invasive coronary angiography. The size of the calcified coronary artery plaques was graded subjectively as small, moderate, or large. Using postprocessing techniques such as segmentation and tracking, we attempted to determine whether the calcified lesions were obstructive (≥ 50% diameter narrowing) or nonobstructive (< 50% diameter narrowing). Concordance with invasive coronary angiography was then determined.RESULTS. Calcified coronary artery plaques were graded by coronary CTA as small at 61 locations, moderate at 22 locations, and large at 43 locations. Of the 61 small calcified coronary artery plaques, 5% were...
91 citations
References
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TL;DR: In this article, the authors used ultrafast computed tomography (UCT) to detect and quantify coronary artery calcium levels in 584 subjects (mean age 48 +/- 10 years) with and without clinical coronary artery disease.
6,545 citations
TL;DR: The Clinical Efficacy Assessment Subcommittee of the American College of Physicians–American Society of Internal Medicine acknowledges the scientific validity of this product as a background paper and as a review that captures the levels of evidence in the management of patients with chronic stable angina as of November 17, 2002.
Abstract: The Clinical Efficacy Assessment Subcommittee of the American College of Physicians–American Society of Internal Medicine acknowledges the scientific validity of this product as a background paper and as a review that captures the levels of evidence in the management of patients with chronic stable angina as of November 17, 2002
The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines regularly reviews existing guidelines to determine when an update or a full revision is needed This process gives priority to areas in which major changes in text, and particularly recommendations, are merited on the basis of new understanding or evidence Minor changes in verbiage and references are discouraged
The ACC/AHA/American College of Physicians–American Society of Internal Medicine (ACP-ASIM) Guidelines for the Management of Patients With Chronic Stable Angina, which were published in June 1999, have now been updated The full-text guideline incorporating the updated material is available on the Internet (wwwaccorg or wwwamericanheartorg) in both a track-changes version showing the changes in the 1999 guideline in strike-out (deleted text) and highlighting …
1,796 citations
TL;DR: Evaluated diagnostic accuracy of multislice computed tomography (MSCT) coronary angiography using a new 64-slice scanner indicates high quantitative and qualitative diagnostic accuracy in comparison to QCA in a broad spectrum of patients.
1,503 citations
TL;DR: In this article, the diagnostic accuracy of 64-slice computed tomography (CT) to identify and quantify atherosclerotic coronary lesions in comparison with catheter-based angiography and intravascular ultrasound (IVUS) was evaluated.
1,169 citations