Relationship Between Noninvasive Coronary Angiography With Multi-Slice Computed Tomography and Myocardial Perfusion Imaging

Spevack, Daniel M.; Levsky, Jeffrey M.

doi:10.1016/j.jacc.2006.05.080

Cited by 426 publications

(235 citation statements)

References 24 publications

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“…While not a focus of this systematic review, several studies have attempted to examine CCTA's ability to diagnose functional cardiac deficits, using SPECT or another functional test as a reference. 2,74,75 While negative predictive value for these abnormalities was similar to that reported in the ICA-reference studies, positive predictive value only ranged between 50-60%, which is indicative of overestimation of clinically significant obstruction by CCTA. Some have posited that, with increasingly precise technology, the ability to use CCTA to study blood flow and perfusion deficits will be heightened; evidence has not yet accumulated to evaluate this hypothesis.…”

Section: Discussionsupporting

confidence: 76%

The Diagnostic Performance of Multi-slice Coronary Computed Tomographic Angiography: a Systematic Review

2010

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BACKGROUND:The use of coronary computed tomographic angiography (CCTA) for evaluation of patients with suspected coronary artery disease (CAD) is growing rapidly, yet questions remain regarding its diagnostic accuracy and its impact on clinical decision-making and patient outcomes. METHODS: A systematic literature review was conducted to identify studies examining (a) CCTA's diagnostic accuracy; and (b) the impact of CCTA on clinical decisionmaking and/or patient outcomes. Diagnostic accuracy estimates were limited to patient-based analyses of occlusion; outcome studies were eligible for inclusion if they involved patients at low-to-intermediate risk of CAD. Pooled accuracy estimates were derived using bivariate random effects models; non-diagnostic CCTA results were conservatively assumed to be false positives. RESULTS: A total of 42 diagnostic accuracy studies and 11 patient outcome studies were identified. The pooled mean sensitivity for CCTA in primary analyses was 98% (95% CI: 96%, 99%); specificity was 85% (81%, 89%). A small number of outcome studies set primarily in the emergency department found triage of low-risk patients using CCTA produced no serious adverse outcomes and was time-saving relative to standard triage care. Outcome studies in the outpatient setting were limited to four case series that did not directly compare patient care or outcomes with those of contemporaneous patients evaluated without CCTA. CONCLUSIONS: CCTA appears to have high diagnostic accuracy in patients with suspected CAD, but its potential impact on clinical decision-making and patient outcomes is less well-understood, particularly in non-emergent settings.KEY WORDS: multislice CT; coronary artery disease; diagnostic value; systematic review.

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Section: Discussionsupporting

confidence: 76%

The Diagnostic Performance of Multi-slice Coronary Computed Tomographic Angiography: a Systematic Review

2010

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“…31,32 Most prior studies that have evaluated the clinical utility of coronary CTA in symptomatic low to intermediate risk ED patients have been limited by sample size, 21,22,24,25,27 short follow-up periods, 22,24,28 or use of concurrent diagnostic tests for clinical decisionmaking. 23,33 Hoffman et al 24 studied 103 admitted intermediate risk patients and found that 73 patients without significant coronary disease on coronary CTA had a 100% negative predictive value for ACS during index hospitalization, as well as for major adverse cardiac events after 5 months. Rubinshtein et al 25 found a 100% negative predictive value for the ED diagnosis of ACS in 58 patients.…”

Section: Discussionmentioning

confidence: 99%

One‐year Outcomes Following Coronary Computerized Tomographic Angiography for Evaluation of Emergency Department Patients with Potential Acute Coronary Syndrome

Hollander

Chang

Shofer

et al. 2009

Academic Emergency Medicine

115

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Objectives: Coronary computerized tomographic angiography (CTA) has high correlation with cardiac catheterization and has been shown to be safe and cost-effective when used for rapid evaluation of lowrisk chest pain patients from the emergency department (ED). The long-term outcome of patients discharged from the ED with negative coronary CTA has not been well studied. Methods:The authors prospectively evaluated consecutive low-to intermediate-risk patients who received coronary CTA in the ED for evaluation of a potential acute coronary syndrome (ACS). Patients with cocaine use, known cancer, and significant comorbidity reducing life expectancy and those found to have significant disease (stenosis ‡ 50% or ejection fraction < 30%) were excluded. Demographics, medical and cardiac history, labs, and electrocardiogram (ECG) results were collected. Patients were followed by telephone contact and record review for 1 year. The main outcome was 1-year cardiovascular death or nonfatal acute myocardial infarction (AMI).Results: Of 588 patients who received coronary CTA in the ED, 481 met study criteria. They had a mean (±SD) age of 46.1 (±8.8) years, 63% were black or African American, and 60% were female. There were 53 patients (11%) rehospitalized and 51 patients (11%) who received further diagnostic testing (stress or catheterization) over the subsequent year. There was one death (0.2%; 95% confidence interval [CI] = 0.01% to 1.15%) with unclear etiology, no AMI (0%; 95% CI = 0 to 0.76%), and no revascularization procedures (0%; 95% CI = 0 to 0.76%) during this time period.Conclusions: Low-to intermediate-risk patients with a Thrombosis In Myocardial Infarction (TIMI) score of 0 to 2 who present to the ED with potential ACS and have a negative coronary CTA have a very low likelihood of cardiovascular events over the ensuing year.ACADEMIC EMERGENCY MEDICINE 2009; 16:693-698 ª

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“…13 In a single-center trial that enrolled 108 subjects with suspected coronary artery disease, Dewey et al showed that MSCT was more specific in viewing the coronary lesions compared to MRI; however, due to latest developments in CMR, its diagnostic precision has gradually improved in the last years. 14 The ability of CMR to detect information on ischemia induced by stress and myocardial viability are extremely important in making the best possible therapeutic decision and to improve the outcome of subjects with MI.…”

Section: Cmr Versus Msct Coronary Angiographymentioning

confidence: 99%

The Role of Coronary Computed Tomography Angiography and Cardiac Magnetic Resonance in STEMI Patients with Normal Coronary Angiography

Beganu¹,

Rodean²,

Bordi³

et al. 2017

Journal of Interdisciplinary Medicine

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Usually, the diagnosis of myocardial infarction based on patient symptoms, electrocardiogram (ECG) changes, and cardiac enzymes, is not a challenge for cardiologists. The correlation between coronary anatomy and the ECG territories that present ischemic changes can help the clinician to estimate which coronary artery presents lesions upon performing a coronary angiogram. In certain situations, the diagnosis of myocardial infarction can be difficult due to the lack of correlations between the clinical and paraclinical examinations and the coronary angiogram. In some cases, patients with chest pain and ST-segment elevation on the ECG tracing present with a normal coronary angiography. In other cases, patients without important changes on the ECG can present critical lesions or even occlusions upon angiographic examination. The aim of this article is to highlight the role of noninvasive coronary magnetic resonance and multi-slice computed tomography in patients with ST-segment elevation myocardial infarction and normal coronary angiography.

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Relationship Between Noninvasive Coronary Angiography With Multi-Slice Computed Tomography and Myocardial Perfusion Imaging

Cited by 426 publications

References 24 publications

The Diagnostic Performance of Multi-slice Coronary Computed Tomographic Angiography: a Systematic Review

The Diagnostic Performance of Multi-slice Coronary Computed Tomographic Angiography: a Systematic Review

One‐year Outcomes Following Coronary Computerized Tomographic Angiography for Evaluation of Emergency Department Patients with Potential Acute Coronary Syndrome

The Role of Coronary Computed Tomography Angiography and Cardiac Magnetic Resonance in STEMI Patients with Normal Coronary Angiography

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