Abstract 4715: Diagnostic Accuracy of Non-invasive 64-row Computed Tomographic Coronary Angiography (CCTA) Compared with Myocardial Perfusion Imaging (MPI): The PICTURE Study, A Pospective Multicenter Trial
Although multiple studies have shown excellent accuracy statistics for non-invasive angiography by 64-CCTA, most studies comparing nuclear imaging with CCTA were performed on patients already referred for cardiac catheterization, introducing verification and referral bias. This prospective trial evaluated the diagnostic accuracy of 64-row CCTA to detect obstructive coronary stenosis compared to MPI, using quantitative coronary angiography (QCA) as a reference standard.
Methods: 12 sites prospectively enrolled 230 patients (pts) [52% male, 56.9 yrs] with chest pain who were referred for MPI to assess CAD. To date, 48 patients were clinically referred for invasive coronary angiography (ICA) for either positive MPI or abnormal CCTA. All Pts underwent both MPI and CCTA (Lightspeed VCT/Visipaque 320, GE Healthcare) prior to ICA. CCTAs were graded on a 15-segment AHA model by 2 blinded readers for presence of obstructive stenosis (≥50% or ≥70%); MPI was graded by 2 blinded readers using a 17 segment model for estimation of the % myocardium ischemic or with stress defects. ICAs were independently graded for % stenosis by QCA. Efficacy of MPI and CCTA were assessed including all vessel segments for per-patient and per-vessel analyses.
Results: Prevalence of stenosis ≥50% by ICA was 52.1% (25/48). The diagnostic accuracy (per-patient analysis) of CCTA and stress MPI compared to ICA are reported in Table 1⇓. For ≥50% stenosis, the CTA odds ratio for ICA disease was 51.75 (95% CI=8.50–314.94). For SSS ≥5%, the odds ratio for ICA CAD was 12.73 (95% CI=2.43–66.55). Using ROC curve analysis, CCTA was better at classifying obstructive CAD when compared to MPI (Area=0.87 vs. 0.76, p<0.0001).
Conclusions: This study represents the first prospective multicenter data comparing 64-row CCTA to MPI, demonstrating high diagnostic accuracy of CCTA to reliably detect >50% and >70% stenosis in chest pain patients.