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European Heart Journal Advance Access published online on August 14, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp304
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Coronary CT angiography and myocardial perfusion imaging to detect flow-limiting stenoses: a potential gatekeeper for coronary revascularization?

Oliver Gaemperli1, Lars Husmann1, Tiziano Schepis1, Pascal Koepfli1, Ines Valenta1, Walter Jenni1, Hatem Alkadhi2, Thomas F. Luscher1 and Philipp A. Kaufmann1,3,*

1 Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
2 Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
3 Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland

Received 17 November 2008; revised 5 May 2009; accepted 30 June 2009 * Corresponding author. Tel: +41 44 255 35 55, Fax: +41 44 255 44 14, Email: pak{at}usz.ch

Aims: To evaluate the diagnostic accuracy of a combined non-invasive assessment of coronary artery disease with coronary CT angiography (CTA) and myocardial perfusion imaging (MPI) for the detection of flow-limiting coronary stenoses and its potential as a gatekeeper for invasive examination and treatment.

Methods and results: In 78 patients (mean age 65 ± 9 years) referred for coronary angiography (CA), additional CTA and MPI (using single-photon emission-computed tomography) were performed and the findings not communicated. Detection of flow-limiting stenoses (justifying revascularization) by the combination of CTA and MPI (CTA/MPI) was compared with the combination of quantitative coronary angiography (QCA) plus MPI (QCA/MPI), which served as standard of reference. The findings of both combinations were related to the treatment strategy (revascularization vs. medical treatment) chosen in the catheterization laboratory based on the CA findings. Sensitivity, specificity, positive and negative predictive value, and accuracy of CTA/MPI for the detection of flow-limiting coronary stenoses were 100% each. More than half of revascularization procedures (21/40, 53%) was performed in patients without flow-limiting stenoses and 76% (47/62) of revascularized vessels were not associated with ischaemia on MPI.

Conclusion: The combined non-invasive approach CTA/MPI has an excellent accuracy to detect flow-limiting coronary stenoses compared with QCA/MPI and its use as a gatekeeper appears to make a substantial part of revascularization procedures redundant.

Key Words: Coronary CT angiography • Myocardial perfusion imaging • Conventional coronary angiography • Coronary artery disease

This paper was guest edited by Prof. Van de Werf, Department of Cardiology, University Hospitals Leuven, Belgium


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