Author + information
- Received June 2, 2015
- Revision received July 30, 2015
- Accepted August 5, 2015
- Published online May 1, 2016.
- Matthew J. Budoff, MDa,∗ (, )
- Ryo Nakazato, MDb,
- G.B. John Mancini, MDc,
- Heidi Gransar, PhDb,
- Jonathon Leipsic, MDc,
- Daniel S. Berman, MDb and
- James K. Min, MDd
- aDepartment of Medicine, Los Angeles Biomedical Research Center, Torrance, California
- bCedars-Sinai Heart Institute and Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
- cDepartment of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- dDepartment of Radiology, New York–Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Matthew J. Budoff, Department of Medicine, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Center, 1124 W. Carson Street, Torrance, California 90502.
Objectives The goal of this study was to compare the diagnostic performance of coronary computed tomography angiography (CTA) versus quantitative coronary angiography (QCA) for the detection of lesion-specific ischemia using fractional flow reserve (FFR) as the gold standard.
Background Coronary CTA has emerged as a noninvasive method for accurate detection and exclusion of high-grade coronary stenoses. FFR is the gold standard for determining lesion-specific ischemia and has been shown to improve clinical outcomes when guiding revascularization.
Methods A total of 252 patients from 5 countries were prospectively enrolled (mean age 63 years; 71% male). Patients underwent coronary CTA and invasive coronary angiography (ICA) with FFR in 407 lesions. Coronary CTA, QCA, and FFR were interpreted by independent core laboratories. Stenosis severity according to coronary CTA and QCA were graded as 0% to 29%, 30% to 49%, 50% to 69%, and 70% to 100%; stenosis ≥50% was considered anatomically obstructive. Lesion-specific ischemia was defined according to FFR ≤0.8, whereas QCA and coronary CTA stenosis ≥50% were considered obstructive. Diagnostic accuracy and areas under the receiver-operating characteristics curve (AUC) for lesion-specific ischemia was assessed.
Results According to FFR, ischemia was present in 151 (37%) of 407 lesions. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 69%, 79%, 63%, 55%, and 83% for coronary CTA; and 71%, 74%, 70%, 59%, and 82% for QCA. AUC for identification of ischemia-causing lesions was similar: 0.75 for coronary CTA and 0.77 for QCA (p = 0.6). No differences between CTA and QCA existed for discrimination of ischemia within the left anterior descending artery (AUC 0.71 vs. 0.73; p = 0.6), left circumflex artery (AUC 0.78 vs. 0.85; p = 0.4), and right coronary artery (AUC 0.80 vs. 0.83; p = 0.6).
Conclusions CTA and ICA exhibited similar diagnostic performance for the detection and exclusion of lesion-specific ischemia. Using a true reference standard to determine appropriate revascularization targets, 3-dimensional coronary CTA performed as well as 2-dimensional ICA.
- coronary angiography
- coronary CT
- diagnostic accuracy
- fractional flow reserve
- multidetector computed tomography
Drs. Budoff, Leipsic, and Min are consultants for HeartFlow, the funding source of the overall study; however, this analysis was not funded by any source. Dr. Budoff has received grant support from GE Healthcare and the National Institutes of Health. Dr. Min has served as a consultant for Abbott Vascular, Neograft Technologies, MyoKardia, and CardioDx; member of the Scientific Advisory Board for Arineta; has a research agreement with GE Healthcare; ownership in MDDX and AutoPlaq; and has received grants from the National Institutes of Health/National Heart, Lung, and Blood Institute (R01HL111141, R01HL115150, and R01HL118019). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. David Bluemke, MD, served as Guest Editor for this paper.
- Received June 2, 2015.
- Revision received July 30, 2015.
- Accepted August 5, 2015.
- American College of Cardiology Foundation