Sixty-four-slice computed tomography coronary angiography compared with myocardial perfusion scintigraphy for the diagnosis of functionally significant coronary stenoses in patients with a low to intermediate likelihood of coronary artery disease

Clinical effectiveness of coronary computed tomographic angiography in the triage of patients to cardiac catheterization and revascularization after inconclusive stress testing: results of a 2-year prospective trial

“…17 Of note, part of this problem could be related to lower sensitivity of stress perfusion studies to diagnose epicardial disease with 50% luminal stenosis, whereas a stenosis threshold of 70% demonstrates better agreement between stress perfusion and CTA. 18 The present prospective study supports and extends the findings of previous retrospective studies investigating the role of CCTA in patients after inconclusive and mildly positive stress tests. A retrospective study of 994 patients with symptoms and equivocal stress test findings reported that only 160 (16%) underwent catheterization during 6 months of follow-up, with an overall diagnostic accuracy of 87% in those patients.…”

64-slice CT angiography for the detection of functionally significant coronary stenoses: comparison with stress myocardial perfusion imaging

“…The low PPV (37%, 25/68) for diameter stenosis of $50% to predict ischaemia in the present study is in line with previous studies which reported ischaemia in approximately 30-60% for patients with $50% stenosis on 64-slice CTA [6,8,9], and suggests that this level of stenosis should not be used to stratify patients for invasive No stenosis 311 46 8 2 1-49% 11 62 16 0 50-69% 3 3 19 9 $70% 1 1 6 14 CTA, CT angiography; QCA, quantitative coronary angiography.…”

“…Our data reveal that the yield of abnormal SPECT MPI studies (a PPV of 74%) and the diagnostic accuracy (89%) increased substantially when a cut-off of 70% diameter stenosis on 64-slice CTA was used for the detection of ischaemia rather than a 50% cut-off. Interestingly, somewhat higher agreement (86%, 6/7) for $70% diameter narrowing on CTA and ischaemia on functional testing has been reported by Nicol et al [9], who compared 64-slice CTA Tc tetrofosmin in 52 consecutive patients, of whom a smaller proportion (13%, 7/52) had abnormal MPI studies. Conversely, a lower PPV (55%, 11/20) for diameter stenosis of $70% to detect ischaemia was recently reported by Haramati et al [11], who compared 64-slice CTA and SPECT MPI using treadmill exercise or adenosine and 201 Tl/ 99m Tc sestamibi in 61 consecutive patients.…”

“…However, management decisions such as referral for revascularisation remain largely dependent on the severity of symptoms in combination with the extent of ischaemia demonstrated during functional testing. Unfortunately, this important information is currently not obtained from multislice CTA, and the diagnostic value of CTA in the detection of functionally significant coronary artery lesions as defined by reversible or fixed perfusion defects on myocardial perfusion imaging (MPI) remains uncertain as only limited data are available on this specific issue [5][6][7][8][9][10][11].…”

Is Computed Tomography Coronary Angiography the Most Accurate and Effective Noninvasive Imaging Tool to Evaluate Patients With Acute Chest Pain in the Emergency Department?

“…40 Within the intermediate range of stenosis (40% to 70%), there is a gradual reduction in hyperemic flow with progressive levels of stenosis within this range. 41 The determination of minor differences in percent stenosis with CCT is challenging and therefore assessment of physiological significance is more difficult.…”