Non-invasive detection of significant coronary artery disease with multi-section computed tomography angiography in patients with suspected coronary artery disease

AIMThe objective of this prospective study was to compare the accuracy of multi-section computed tomography (MSCT) coronary angiography with invasive selective coronary angiography in the detection of significant coronary stenosis (≥50% lumen diameter narrowing).METHODSThirty consecutive patients (mean age 59±10 years) with suspected coronary artery disease underwent both invasive coronary angiography and MSCT using a 40-section multidetector row machine with temporal resolution of 53 ms. Reconstruction images were performed in eight phases of the cardiac cycle. Images of MSCT and invasive coronary angiography were analysed using the 16-segment model of the American Heart Association.RESULTSA total of 480 segments from 30 patients were evaluated. Coronary segments distal to a vessel occlusion and segments with coronary stent were not considered for analysis (20 segments in total). Ninety-four (20.4%) segments showed significant (≥50%) stenosis by invasive coronary angiogram. The accuracy of coronary MSCT was computed on a per segment basis. Average sensitivity, specificity, positive predictive value, and negative predictive value of MSCT were 99, 98, 94, and 99%, respectively.CONCLUSIONThis study demonstrated that MSCT is as reliable as coronary angiography at detecting significant obstructive coronary artery disease. In selected groups of patients, it may replace the more invasive and potentially more dangerous conventional coronary angiography.