Diagnostic Accuracy of 320-Multi-detector Row Computed Tomography to Detect Coronary Artery Disease and its Comparison to Coronary Angiography

Abstract

BACKGROUND Coronary artery disease is a significant cause of morbidity and mortality. Selective invasive coronary angiography remains the gold standard to determine the extent of disease however multi-detector row computed tomography is non-invasive in nature with advantage in providing coronary artery calcium score and plaque burden estimation. In this study, we determined the diagnostic accuracy of multi-detector row computed tomography for stenoses of the coronary arteries in comparison with the conventional standard cardiac angiography.

METHODS This was a hospital-based, cross-sectional study conducted at Shahid Gangalal National Heart Centre and Bir Hospital, Kathmandu, Nepal. 110 patients who had undergone cardiac computed tomography angiography and conventional invasive coronary angiography for a year were enrolled. Comparative study in terms of sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated.

RESULTS A total of 110 patients were enrolled. The mean total coronary artery calcium score was 190.63 ± 312.61 Agatston units. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cardiac computed tomography angiography were 81.4%, 91.3%, 65.7%, 96.0%, and 89.6% respectively. Overall sensitivity, specificity, positive and negative predictive values for mild (<50%) stenosis were 47.4%, 95.1%, 34.8% and 97.1% respectively, moderate (50-69%) stenosis were 30.4%, 96.8%, 19.4% and 98.2% respectively and severe (≥ 70%) stenosis were 65.7%, 95.6%, 60.5% and 96.4% respectively.

CONCLUSIONS Coronary computed tomography angiography has a high diagnostic accuracy, good sensitivity and negative predictive value, and positive predictive value similar with invasive coronary angiography with exclusion of calcified extensive plaque burden segments for higher yield.