Ontario multidetector computed tomographic coronary angiography study: field evaluation of diagnostic accuracy

Published on Jun 13, 2011in JAMA Internal Medicine20.768
· DOI :10.1001/archinternmed.2011.74
Benjamin J.W. Chow39
Estimated H-index: 39
Michael R. Freeman66
Estimated H-index: 66
+ 14 AuthorsRon Goeree47
Estimated H-index: 47
Background: 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.ThetruediagnosticaccuracyofCTCAinthe“real world” remains uncertain. We conducted a field evaluation comparing multidetector CTCA with invasive CA (ICA)tounderstandCTCA’sdiagnosticaccuracyinarealworld setting. Methods:A multicenter cohort study of patients awaitingICAwasconductedbetweenSeptember2006andJune 2009.Allpatientshadeitheraloworanintermediatepretest probability for coronary artery disease and underwentCTCAandICAwithin10days.TheresultsofCTCA and ICA were interpreted visually by local expert observers who were blinded to all clinical data and imaging results. 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. Conclusions:ComparedwithICA,CTCAappearstohave good accuracy; however, there was variability in diagnostic accuracy across centers. Factors affecting institutional variability need to be better understood before CTCAisuniversallyadopted.Additionalreal-worldevaluationsareneededtofullyunderstandtheimpactofCTCA on clinical care. Trial Registration: Identifier: NCT00371891
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