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Coronary Computed Tomographic Angiography Does Not Accurately Predict the Need of Coronary Revascularization in Patients with Stable Angina

Authors
 Sung-Jin Hong  ;  Ae-Young Her  ;  Yongsung Suh  ;  Hoyoun Won  ;  Deok-Kyu Cho  ;  Yun-Hyeong Cho  ;  Young-Won Yoon  ;  Kyounghoon Lee  ;  Woong Chol Kang  ;  Yong Hoon Kim  ;  Sang-Wook Kim  ;  Dong-Ho Shin  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Young-Guk Ko  ;  Byoung-Wook Choi  ;  Donghoon Choi  ;  Yangsoo Jang  ;  Myeong-Ki 
Citation
 Yonsei Medical Journal, Vol.57(5) : 1079-1086, 2016 
Journal Title
 Yonsei Medical Journal 
ISSN
 0513-5796 
Issue Date
2016
MeSH
Aged ; Angina, Stable/diagnostic imaging* ; Coronary Angiography/methods* ; Coronary Stenosis/diagnostic imaging* ; Female ; Humans ; Male ; Middle Aged ; Myocardial Revascularization ; Predictive Value of Tests ; Tomography, X-Ray Computed ; United States
Keywords
Multidetector computed tomography ; coronary artery disease ; myocardial revascularization
Abstract
PURPOSE: To evaluate the ability of coronary computed tomographic angiography (CCTA) to predict the need of coronary revascularization in symptomatic patients with stable angina who were referred to a cardiac catheterization laboratory for coronary revascularization. MATERIALS AND METHODS: Pre-angiography CCTA findings were analyzed in 1846 consecutive symptomatic patients with stable angina, who were referred to a cardiac catheterization laboratory at six hospitals and were potential candidates for coronary revascularization between July 2011 and December 2013. The number of patients requiring revascularization was determined based on the severity of coronary stenosis as assessed by CCTA. This was compared to the actual number of revascularization procedures performed in the cardiac catheterization laboratory. RESULTS: Based on CCTA findings, coronary revascularization was indicated in 877 (48%) and not indicated in 969 (52%) patients. Of the 877 patients indicated for revascularization by CCTA, only 600 (68%) underwent the procedure, whereas 285 (29%) of the 969 patients not indicated for revascularization, as assessed by CCTA, underwent the procedure. When the coronary arteries were divided into 15 segments using the American Heart Association coronary tree model, the sensitivity, specificity, positive predictive value, and negative predictive value of CCTA for therapeutic decision making on a per-segment analysis were 42%, 96%, 40%, and 96%, respectively. CONCLUSION: CCTA-based assessment of coronary stenosis severity does not sufficiently differentiate between coronary segments requiring revascularization versus those not requiring revascularization. Conventional coronary angiography should be considered to determine the need of revascularization in symptomatic patients with stable angina.
DOI
10.3349/ymj.2016.57.5.1079
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
고영국(Ko, Young Guk) ORCID logo https://orcid.org/0000-0001-7748-5788
김병극(Kim, Byeong Keuk) ORCID logo https://orcid.org/0000-0003-2493-066X
김중선(Kim, Jung Sun) ORCID logo https://orcid.org/0000-0003-2263-3274
신동호(Shin, Dong Ho) ORCID logo https://orcid.org/0000-0002-7874-5542
윤영원(Yoon, Young Won) ORCID logo https://orcid.org/0000-0002-0907-0350
장양수(Jang, Yang Soo) ORCID logo https://orcid.org/0000-0002-2169-3112
최동훈(Choi, Dong Hoon) ORCID logo https://orcid.org/0000-0002-2009-9760
최병욱(Choi, Byoung Wook) ORCID logo https://orcid.org/0000-0002-8873-5444
홍명기(Hong, Myeong Ki) ORCID logo https://orcid.org/0000-0002-2090-2031
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/151615
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