Abstract 18928: Diagnosis and Risk Stratification of Coronary Artery Disease by Computed Tomography Angiography and Myocardial Perfusion Imaging
Purpose: Cardiac computed tomography angiography (CCTA) is a useful tool to assess the coronary artery disease (CAD). However, one of the problems of CCTA is low positive predictive value. Myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT) is another noninvasive modality for CAD assessment. The purpose of this study is to evaluate the feasibility of the combination of morphological and functional evaluation to determine the indication of coronary intervention, or evaluate the risk stratification for patients with CAD.
Methods: A total 116 patients (M:F, 73:43, mean age: 62±12 years) underwent both CTA and MPI within 1 month of enrollment. Diagnostic accuracy of CTA, MPI and a combination thereof for the detection of CAD severity was compared with invasive coronary angiography (CAG) in 52 patients. Patients without significant stenosis on CTA, suspected of significant stenosis by CTA but normal MPI findings were classified as stenosis(-), and patients suspected significant CTA stenosis and with reversible or fixed defect on MPI were classified as stenosis(+). Cardiac events were defined as percutaneous coronary intervention or bypass surgery after CTA and MPI, and unexpected coronary event within 1 year after CTA and MPI. For the risk stratification, the diagnostic accuracy of CTA+MPI was compared with cardiac events in all 116 patients.
Results: Coronary artery stenoses were detected in 29/52 (56%) patients by CAG. The diagnostic accuracy of CTA+MPI to detect significant coronary artery stenosis as compared with CAG was as follows: sensitivity 96%, specificity 83%, positive predictive value (PPV) 87%, negative predictive value (NPV) 86%. CTA+MPI showed higher diagnostic accuracy (87%) than CTA (69%) or MPI (77%). Diagnostic accuracy to predict cardiac event by CTA+MPI was follows: sensitivity 92%, specificity 85%, PPV 61%, and NPV 98%. CTA+MPI also showed higher diagnostic accuracy (86%) than CTA (67%) or MPI (63%) for cardiac events.
Conclusion: The diagnosis with CTA and an additional MPI showed superior diagnostic accuracy to for the detection of coronary artery stenosis than CTA or MPI alone. The combination of CTA and MPI was also useful for the risk stratification in patients suspected CAD.
- © 2010 by American Heart Association, Inc.