Study Finds CT Scans Are Effective Tool In Detecting Coronary Artery Disease

Main Category: Cardiovascular / Cardiology
Also Included In: Medical Devices / Diagnostics;  Radiology / Nuclear Medicine;  MRI / PET / Ultrasound
Article Date: 14 Jan 2008 - 1:00 PDT

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Computed tomography (CT) angiography is as accurate as an invasive angiogram in detecting coronary artery disease, according to the findings of the first two prospective multicenter 64-slice scanner trials presented at the annual meeting of the Radiological Society of North America (RSNA).

The Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography (CORE-64) Trial - conducted by researchers at nine international centers, including Beth Israel Deaconess Medical Center - studied 291 patients who were scheduled to undergo invasive coronary angiography for suspected or unknown coronary artery disease. The study found that 64-slice multidetector CT angiography was highly accurate in detecting blockages of greater than 50 percent, with a sensitivity of 85 percent and a specificity of 90 percent. The noninvasive exam was equal in accuracy to invasive angiography in its ability to identify patients to be referred for angioplasty or bypass surgery.

"This study shows that patients with low to intermediate risk of coronary blockages are likely to benefit from a non-invasive scan," said Melvin Clouse, MD, a radiologist at BIDMC and one of two principal trial investigators. "The study suggests that that CT angiography may eventually replace other non-invasive tests that rely on reduction of blood flow to the heart to diagnose arterial blockage."

"CT angiography may indeed replace cardiac catheterization and guide further interventions including risk factor modification/medical therapy, catheter-based, or surgical revascularization," said Roger Laham, MD, a BIDMC cardiologist and co-principal investigator. "This heralds a new and promising era in diagnostic cardiac imaging with cardiologists and radiologists working together to provide best care to our patients."

A second trial, The Assessment by Coronary Computed Tomographic Angiography of Individuals UndeRgoing InvAsive Coronary AngiographY (ACCURACY) Trial compared 64-row coronary computed tomographic angiography (CCTA) to quantitative coronary angiography (QCA).

The results demonstrated that CCTA is highly accurate in detecting coronary blockages in chest pain patients referred for invasive coronary angiography and is also an effective noninvasive method to exclude obstructive coronary blockages.

Sixteen institutions performed CCTA on 232 patients with typical or atypical chest pain prior to invasive coronary angiography. Findings were then compared to those of QCA, the reference standard used to quantify the results of the invasive coronary angiography.

A total of 82 blockages greater than 50 percent in 49 patients and 31 blockages greater than 70 percent were detected in 28 patients by QCA. Per-patient sensitivity and specificity of CCTA were 93 percent and 82 percent, respectively, for blockages greater than 50 percent, and 91 percent and 84 percent for blockages greater than 70 percent. In addition, negative predictive value was 97 to 99 percent.

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and consistently ranks among the top four in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox.

Beth Israel Deaconess Medical Center

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