Chow Benjamin J W, Freeman Michael R, Bowen James M, Levin Leslie, Hopkins Robert B, Provost Yves, Tarride Jean-Eric, Dennie Carole, Cohen Eric A, Marcuzzi Dan, Iwanochko Robert, Moody Alan R, Paul Narinder, Parker John D, O'Reilly Daria J, Xie Feng, Goeree Ron
Department of Radiology, University of Ottawa Heart Institute, Ontario, Canada.
Arch Intern Med. 2011 Jun 13;171(11):1021-9. doi: 10.1001/archinternmed.2011.74. Epub 2011 Mar 14.
Computed tomographic coronary angiography (CTCA) has gained clinical acceptance for the detection of obstructive coronary artery disease. Although single-center studies have demonstrated excellent accuracy, multicenter studies have yielded variable results. The true diagnostic accuracy of CTCA in the "real world" remains uncertain. We conducted a field evaluation comparing multidetector CTCA with invasive CA (ICA) to understand CTCA's diagnostic accuracy in a real-world setting.
A multicenter cohort study of patients awaiting ICA was conducted between September 2006 and June 2009. All patients had either a low or an intermediate pretest probability for coronary artery disease and underwent CTCA and ICA within 10 days. The results of CTCA and ICA were interpreted visually by local expert observers who were blinded to all clinical data and imaging results.
Using a patient-based analysis (diameter stenosis ≥50%) of 169 patients, the sensitivity, specificity, positive predictive value, and negative predictive value were 81.3% (95% confidence interval [CI], 71.0%-89.1%), 93.3% (95% CI, 85.9%-97.5%), 91.6% (95% CI, 82.5%-96.8%), and 84.7% (95% CI, 76.0%-91.2%), respectively; the area under receiver operating characteristic curve was 0.873. The diagnostic accuracy varied across centers (P < .001), with a sensitivity, specificity, positive predictive value, and negative predictive value ranging from 50.0% to 93.2%, 92.0% to 100%, 84.6% to 100%, and 42.9% to 94.7%, respectively.
Compared with ICA, CTCA appears to have good accuracy; however, there was variability in diagnostic accuracy across centers. Factors affecting institutional variability need to be better understood before CTCA is universally adopted. Additional real-world evaluations are needed to fully understand the impact of CTCA on clinical care.
clinicaltrials.gov Identifier: NCT00371891.
计算机断层扫描冠状动脉造影（CTCA）在检测阻塞性冠状动脉疾病方面已获得临床认可。尽管单中心研究已证明其具有出色的准确性，但多中心研究结果却不尽相同。CTCA在“现实世界”中的真正诊断准确性仍不确定。我们进行了一项现场评估，将多排CTCA与有创冠状动脉造影（ICA）进行比较，以了解CTCA在实际环境中的诊断准确性。
2006年9月至2009年6月对等待ICA的患者进行了一项多中心队列研究。所有患者冠状动脉疾病的预检概率均为低或中度，并在10天内接受了CTCA和ICA检查。CTCA和ICA的结果由对所有临床数据和影像学结果不知情的当地专家观察者进行视觉解读。
对169例患者进行基于患者的分析（直径狭窄≥50%），敏感性、特异性、阳性预测值和阴性预测值分别为81.3%（95%置信区间[CI]，71.0%-89.1%）、93.3%（95%CI，85.9%-97.5%）、91.6%（95%CI，82.5%-96.8%）和84.7%（95%CI，76.0%-91.2%）；受试者操作特征曲线下面积为0.873。各中心的诊断准确性有所不同（P <.001），敏感性、特异性、阳性预测值和阴性预测值分别为50.0%至93.2%、92.0%至100%、84.6%至100%和42.9%至94.7%。
与ICA相比，CTCA似乎具有良好的准确性；然而，各中心的诊断准确性存在差异。在CTCA被普遍采用之前，需要更好地了解影响机构差异的因素。需要进行更多的实际评估，以充分了解CTCA对临床护理的影响。
clinicaltrials.gov标识符：NCT00371891。
