Abstract 17826: Comparison of Diagnostic Accuracy of Coronary CT Angiography during Vasodilator Stress with Routine Clinical Rest CTA
Objectives: Stress perfusion CT-angiography (SP-CTA) is a novel technique to assess the hemodynamic significance of coronary stenosis that does not use B-Blocker or NTG. We aim to compare the accuracy for detection of coronary stenosis in a match cohort of patients (pts) undergoing dual-source SP-CTA with conventional clinical rest CTA (R-CTA).
Methods: Pts with suspected CAD had SP-CTA using retrospectively-gated acquisition during vasodilator adenosine infusion using a Dual-source CT scanner. This group was matched by age, gender and prevalence of significant CAD to pts who underwent routine clinical, retrospectively-gated R-CTA at our institution. Moderate and severe CAD (defined as >50% and >70% stenosis, respectively) were determined by quantitative coronary angiography (QCA), performed within a mean of 60 +/− 12 days of the CT.
Results: Thirty-seven pts who had SP-CTA and 37 pts who had R-CTA were included. Between the SP-CTA and the R-CTA pts, there were no differences in age (60.9 vs. 60.7, p=0.94), males (83.7% vs. 83.7%, p=1.0), prevalence of moderate (64% vs. 59%, p=0.63) or severe CAD (43.2% vs. 40.1%, p=0.81). Between these groups, there was no significant difference on a per-vessel sensitivity (SS) (0.90, 95%CI: 0.76–0.97 vs. 0.80 95% CI: 0.62–0.90, respectively; p=0.19) or specificity (SP) (0.74, 95%CI: 0.65–0.82 vs. 0.69, 95%CI: 0.59–0.77, respectively; p=0.36) for moderate CAD. For severe CAD, the SP-CTA group SS was higher (0.84, 95% CI: 0.60–0.96) compared to the R-CTA group (0.65, 95% CI: 0.38–0.84), although this difference was not statistically significant (p=0.17). The SP for severe CAD between SP-CTA and R-CTA pts was similar (0.76, 95%CI: 0.67–0.83 vs. 0.77, 95%CI: 0.68–0.83 respectively, p=0.83). Of the R-CTA group, 33 (89%) received SL-NTG and 21(58%) received IV-BB prior to the scan. No medications were given to the SP-CTA pts, other than adenosine.
Conclusion: SP-CTA has high accuracy for detection of significant CAD when compared to QCA. There were no differences in SS and SP when compared to R-CTA in a matched cohort with similar prevalence of CAD.
- © 2010 by American Heart Association, Inc.