Dipartimento di Radiologia e Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
Radiol Med. 2010 Apr;115(3):354-67. doi: 10.1007/s11547-009-0456-9. Epub 2009 Nov 9.
This study aimed to evaluate the diagnostic accuracy of stress electrocardiogram (ECG) and computed tomography coronary angiography (CTCA) for the detection of significant coronary artery stenosis (> or =50%) in the real world using conventional CA as the reference standard.
A total of 236 consecutive patients (159 men, 77 women; mean age 62.8+/-10.2 years) at moderate risk and with suspected coronary artery disease (CAD) were enrolled in the study and underwent stress ECG, CTCA and CA. The CTCA scan was performed after i.v. administration of a 100-ml bolus of iodinated contrast material. The stress ECG and CTCA reports were used to evaluate diagnostic accuracy compared with CA in the detection of significant stenosis > or =50%.
We excluded 16 patients from the analysis because of the nondiagnostic quality of stress ECG and/or CTCA. The prevalence of disease demonstrated at CA was 62% (n=220), 51% in the population with comparable stress ECG and CTCA (n=147) and 84% in the population with equivocal stress ECG (n=73). Stress ECG was classified as equivocal in 73 cases (33.2%), positive in 69 (31.4%) and negative in 78 (35.5%). In the per-patient analysis, the diagnostic accuracy of stress ECG was sensitivity 47%, specificity 53%, positive predictive value (PPV) 51% and negative predictive value (NPV) 49%. On stress ECG, 40 (27.2%) patients were misclassified as negative, and 34 (23.1%) patients with nonsignificant stenosis were overestimated as positive. The diagnostic accuracy of CTCA was sensitivity 96%, specificity 65%, PPV 74% and NPV 94%. CTCA incorrectly classified three (2%) as negative and 25 (17%) as positive. The difference in diagnostic accuracy between stress ECG and CTCA was significant (p<0.01).
CTCA in the real world has significantly higher diagnostic accuracy compared with stress ECG and could be used as a first-line study in patients at moderate risk.
本研究旨在使用常规冠状动脉造影（CA）作为参考标准，评估应激心电图（ECG）和计算机断层扫描冠状动脉造影（CTCA）在真实世界中诊断有意义的冠状动脉狭窄（>或=50%）的准确性。
共纳入 236 例连续的中度疑似冠心病（CAD）患者（159 例男性，77 例女性；平均年龄 62.8+/-10.2 岁），行应激 ECG、CTCA 和 CA 检查。CTCA 扫描在静脉注射 100ml 碘造影剂后进行。根据应激 ECG 和 CTCA 报告评估诊断准确性，并与 CA 对>或=50%的狭窄的检测进行比较。
由于应激 ECG 和/或 CTCA 的诊断质量不可靠，我们排除了 16 例患者的分析。CA 显示的疾病患病率为 62%（n=220），在具有可比性的应激 ECG 和 CTCA 人群中为 51%（n=147），在应激 ECG 不确定的人群中为 84%（n=73）。73 例（33.2%）应激 ECG 为不确定，69 例（31.4%）为阳性，78 例（35.5%）为阴性。在患者个体分析中，应激 ECG 的诊断准确性为敏感度 47%，特异度 53%，阳性预测值（PPV）51%，阴性预测值（NPV）49%。在应激 ECG 上，40 例（27.2%）患者被错误地分类为阴性，34 例（23.1%）非狭窄患者被高估为阳性。CTCA 的诊断准确性为敏感度 96%，特异度 65%，PPV 74%，NPV 94%。CTCA 错误地将 3 例（2%）患者分类为阴性，将 25 例（17%）患者分类为阳性。应激 ECG 和 CTCA 的诊断准确性差异有统计学意义（p<0.01）。
在真实世界中，CTCA 的诊断准确性明显高于应激 ECG，可作为中度风险患者的一线检查。
