Paul Heidenreich, MD, MS
What is the accuracy of stress testing and computed tomography coronary angiography (CTCA) for diagnosing coronary artery disease (CAD)?
Blinded comparison of stress testing and CTCA with invasive coronary angiography (ICA).
University medical center in Rotterdam, The Netherlands.
517 patients (mean age 59 y, 61% men) with chest symptoms who were referred for stress testing and ICA. Exclusion criteria were acute coronary syndromes or history of percutaneous coronary stent placement, coronary artery bypass surgery, or myocardial infarction.
Stress testing comprised an exercise electrocardiogram (ECG) or single-photon emission computed tomography (SPECT). The exercise ECG result was defined as positive (horizontal or down-sloping ST-segment depression ≥ 1 mm), equivocal (absent ischemic ST-segment depression, but heart rate < 85% of maximum predicted for age and sex), or negative. SPECT results that were fixed or reversible were considered abnormal. 64-slice or dual-source CTCA results showing ≥ 50% reduction in lumen diameter on visual assessment were considered positive for obstructive CAD.
Quantitative coronary angiography was done within 4 weeks of CTCA. Stenoses were classified as significant if lumen diameter was reduced by ≥ 50% based on a validated algorithm.
Sensitivity, specificity, and likelihood ratios.
CTCA was more accurate than stress testing for diagnosing CAD overall and in patients with an intermediate pretest probability of CAD (Table).
Computed tomography coronary angiography was more accurate than stress testing for diagnosing coronary artery disease.
Test characteristics of stress testing (ST) and CTCA for diagnosing coronary artery disease (CAD)*
*CTCA = computed tomography coronary angiography; diagnostic terms defined in Glossary.
†Low = < 20%, intermediate = 20% to 80%, high = > 80%.
‡Percentage of patients with CAD of those tested.
Heidenreich P. CT coronary angiography was more accurate than stress testing for diagnosing CAD, especially in patients at intermediate risk. Ann Intern Med. ;153:JC4–9. doi: 10.7326/0003-4819-153-8-201010190-02009
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Published: Ann Intern Med. 2010;153(8):JC4-9.
Cardiac Diagnosis and Imaging, Cardiology, Pulmonary/Critical Care.
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