Multi-detector Coronary CT Angiography in Comparison with Invasive Coronary Angiography in the evaluation of Significant Coronary Artery Stenosis

الملخص

Background: Multi-detector CT angiography (MDCTA) allows detection of coronary artery calcium (CAC) and after contrast injection, visualization of the coronary artery lumen. It is commonly assumed that the absence of coronary calcification makes the presence of obstructive coronary lesions highly unlikely. Coronary computed tomographic angiography (CCTA) is a promising way for diagnosis of coronary artery lesion; however, image quality is still impaired by motion artifacts and calcifications. Objectives: To compare the ability of multi-slice coronary CT angiography (MSCCTA) with invasive coronary angiography (ICA) for detection of significant coronary artery stenosis. Patients and methods: It is hospital-based cross sectional study, enrolled 65 patients who attended to Iraqi Center for Heart Disease (Baghdad) and Shaheed Al-Mehrab Cardiac Center (Babylon) from June-2012 to March-2015 complaining from chest pain and fulfill the appropriate use criteria (AUC) for CCTA. Patients who underwent MSCCTA, with lesions causing ? 50% stenosis were subsequently studied by ICA. A total of 450 native main vessels and secondary branches were analyzed by single blind observer. Results: CCTA demonstrated a sensitivity, specificity, positive predictive value (PPV) and a negative predictive value (NPV), when compare with ICA, of 71.5%, 69.5%, 82.4%,67.12%; respectively for primary coronary arteries; and 56.25%, 97%, 62.5%, 95.25%, respectively for secondary coronary arteries. Overall sensitivity and specificity for all coronary arteries and their branches were 64% and 83.3% respectively; with a positive predictive value of 72.5%, and a negative predictive value of 81.1%. Conclusions: The sensitivity, specificity, PPV and NPV of MSCCTA in the evaluation of significant coronary artery disease (CAD) were low compared with ICA.