Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina.

PURPOSE

The aim of this study was to evaluate spiral multidetector computed tomography (MDCT) angiography using 64-slice technique in the detection of functionally relevant coronary artery stenoses (CAS).

METHODS

Thirty-eight patients (62+/-11 years, 28 men) with stable angina (26 with suspected and 12 with known coronary artery disease) were investigated using 64-slice MDCT angiography and gated myocardial perfusion SPECT (gated SPECT); a subgroup of 30 patients had additional invasive coronary angiography (ICA). Stenoses with luminal narrowing of >or=50% were defined as "significant" in MDCT angiography and ICA. MDCT angiography was compared with gated SPECT and the combination of gated SPECT plus ICA with respect to the detection of functionally relevant CAS.

RESULTS

The sensitivity, specificity and negative and positive predictive values of MDCT angiography in detecting reversible perfusion defects on gated SPECT were 63%, 80%, 94% and 32%, respectively, in vessel-based analysis and 71%, 62%, 72% and 60%, respectively, in patient-based analysis. If only reversible perfusion defects on gated SPECT with CAS >or=50% on ICA were considered, the sensitivity, specificity and negative and positive predictive values were, respectively, 85%, 79%, 98% and 33% for vessel-based analysis and 85%, 59%, 83% and 61% for patient-based analysis.

CONCLUSION

Sixty-four slice MDCT angiography failed to predict the functional relevance of CAS, but had a high negative predictive value in the exclusion of functionally relevant CAS in symptomatic patients.