Abstract 17818: Detection of Obstructive Coronary Artery Disease by Non Invasive Anatomical and Functional Imaging. Results of the Multicenter European EVINCI Study
Background: The ideal diagnostic strategy in patients with chronic chest pain is undefined. We investigated the accuracy of non invasive imaging for detecting obstructive coronary artery disease (CAD) in patients with stable anginal symptoms referred to 17 European centres with state of the art technologies.
Methods: Out of 697 patients with stable chest pain and intermediate probability (20-90%) of CAD, 490 (301 males, 60±9 yrs) underwent both anatomical imaging by coronary computed tomography angiography (CCTA) and at least one functional imaging test. Onset of new wall motion abnormalities was evaluated by stress echocardiography or cardiac magnetic resonance (CMR); myocardial perfusion was evaluated by stress single-photon emission computed tomography (SPECT) or positron emission tomography (PET). If at least one test was abnormal, patients underwent invasive coronary angiography. Obstructive CAD (primary end-point) was defined at angiography as ≥70% or 30-70% stenosis with fractional flow reserve ≤0.8. Integrated anatomical and functional strategies were considered positive if at least one test was abnormal. Image analysis was performed at individual centres as in clinical practice.
Results: The pre-test probability of CAD was 65% [interquartile range 33-75%], the prevalence of obstructive CAD was 28%. Performance of different imaging approaches is compared in the table. CCTA was the most accurate imaging technique. The perfusion-based approach was more sensitive (P<0.001) than the wall motion-based approach. Strategies integrating anatomical and functional imaging were more accurate than functional imaging alone.
Conclusions: CCTA is the most accurate technique for predicting obstructive CAD, defined by invasive angiography, in a multicenter European population with disease prevalence of 28%. Combination with CCTA significantly improves the diagnostic performance of the functional tests.
- Coronary heart disease
- Cardiac CT
- Myocardial perfusion
- Stress echocardiography
- Magnetic resonance imaging
- © 2013 by American Heart Association, Inc.