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European Heart Journal Advance Access published online on October 14, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn454
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Computed tomographic angiography or conventional coronary angiography in therapeutic decision-making

Lieuwe H. Piers1,*, Riksta Dikkers2, Tineke P. Willems2, Bart J.G.L. de Smet1, Matthijs Oudkerk2, Felix Zijlstra1 and René A. Tio1

1 Department of Cardiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands
2 Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

Received 14 March 2008; revised 11 September 2008; accepted 18 September 2008.

* Corresponding author. Tel: +31 50 3616161, Fax: +31 50 3614391, Email: l.h.piers{at}thorax.umcg.nl

Aims: To evaluate non-invasive angiography using dual-source computed tomography (CT) for the determination of the most appropriate therapeutic strategy in patients with suspected coronary artery disease (CAD).

Methods and results: CT angiography (Dual Source CT, Somatom Definition, Siemens Medical Systems, Forchheim, Germany) was performed in 60 consecutive patients [51 men, median age 64 (57–70) years] scheduled for elective coronary angiography. Both techniques were used to evaluate the presence of CAD, significant stenosis, and the need for revascularization therapy. Sensitivity and specificity for the presence of significant stenosis were: per segment (n = 766) 62% (95% CI 50–72) (64/104) and 79% (95% CI 74–84) (526/662), respectively; per patient (n = 60) 100% (95% CI 91–100) (38/38) and 45% (95% CI 24–68) (10/22), respectively. In therapeutic decision-making based on CT angiography, sensitivity, specificity, positive and negative predictive values for intervention were 97% (95% CI 84–100) (36/37), 48% (95% CI 27–69) (11/23), 75% (95% CI 60–86) (36/48), and 92% (95% CI 60–100) (11/12), respectively. If a revascularization procedure was needed, the CT angiographic data indicated the appropriate modality (percutaneous coronary intervention or coronary artery bypass grafting) in 70% (26/36) of patients.

Conclusion: Although imaging qualities have improved considerably, CT angiography cannot be used for definitive therapeutic decision-making with regard to revascularization procedures in patients with suspected CAD.

Key Words: Dual-source computed tomography • Coronary angiography • Therapeutic decision


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