TY - JOUR
T1 - The accuracy of coronary CT angiography in patients with coronary calcium score above 1000 Agatston Units
T2 - Comparison with quantitative coronary angiography: Coronary CT Angiography in High Coronary Calcium
AU - Kwan, Alan C.
AU - Gransar, Heidi
AU - Tzolos, Evangelos
AU - Chen, Billy
AU - Otaki, Yuka
AU - Klein, Eyal
AU - Pope, Adele J.
AU - Han, Donghee
AU - Howarth, Andrew
AU - Jain, Nishita
AU - Dey, Damini
AU - Miller, Robert JH
AU - Cheng, Victor
AU - Azarbal, Babak
AU - Berman, Daniel S.
N1 - Funding Information:
Alan Kwan reports funding from NIH T32HL116273 and the Doris Duke Charitable Foundation Grant 2020059. Adele Pope was supported by a grant from the Heart Foundation of New Zealand Research. The work was supported by a grant from Dr. Miriam and Sheldon G. Adelson Medical Research Foundation.
Publisher Copyright:
© 2021 Society of Cardiovascular Computed Tomography
PY - 2021/3/20
Y1 - 2021/3/20
N2 - Background: High amounts of coronary artery calcium (CAC) pose challenges in interpretation of coronary CT angiography (CCTA). The accuracy of stenosis assessment by CCTA in patients with very extensive CAC is uncertain. Methods: Retrospective study was performed including patients who underwent clinically directed CCTA with CAC score >1000 and invasive coronary angiography within 90 days. Segmental stenosis on CCTA was graded by visual inspection with two-observer consensus using categories of 0%, 1–24%, 25–49%, 50–69%, 70–99%, 100% stenosis, or uninterpretable. Blinded quantitative coronary angiography (QCA) was performed on all segments with stenosis ≥25% by CCTA. The primary outcome was vessel-based agreement between CCTA and QCA, using significant stenosis defined by diameter stenosis ≥70%. Secondary analyses on a per-patient basis and inclusive of uninterpretable segments were performed. Results: 726 segments with stenosis ≥25% in 346 vessels within 119 patients were analyzed. Median coronary calcium score was 1616 (1221–2118). CCTA identification of QCA-based stenosis resulted in a per-vessel sensitivity of 79%, specificity of 75%, positive predictive value (PPV) of 45%, negative predictive value (NPV) of 93%, and accuracy 76% (68 false positive and 15 false negative). Per-patient analysis had sensitivity 94%, specificity 55%, PPV 63%, NPV 92%, and accuracy 72% (30 false-positive and 3 false-negative). Inclusion of uninterpretable segments had variable effect on sensitivity and specificity, depending on whether they are considered as significant or non-significant stenosis. Conclusions: In patients with very extensive CAC (>1000 Agatston units), CCTA retained a negative predictive value > 90% to identify lack of significant stenosis on a per-vessel and per-patient level, but frequently overestimated stenosis.
AB - Background: High amounts of coronary artery calcium (CAC) pose challenges in interpretation of coronary CT angiography (CCTA). The accuracy of stenosis assessment by CCTA in patients with very extensive CAC is uncertain. Methods: Retrospective study was performed including patients who underwent clinically directed CCTA with CAC score >1000 and invasive coronary angiography within 90 days. Segmental stenosis on CCTA was graded by visual inspection with two-observer consensus using categories of 0%, 1–24%, 25–49%, 50–69%, 70–99%, 100% stenosis, or uninterpretable. Blinded quantitative coronary angiography (QCA) was performed on all segments with stenosis ≥25% by CCTA. The primary outcome was vessel-based agreement between CCTA and QCA, using significant stenosis defined by diameter stenosis ≥70%. Secondary analyses on a per-patient basis and inclusive of uninterpretable segments were performed. Results: 726 segments with stenosis ≥25% in 346 vessels within 119 patients were analyzed. Median coronary calcium score was 1616 (1221–2118). CCTA identification of QCA-based stenosis resulted in a per-vessel sensitivity of 79%, specificity of 75%, positive predictive value (PPV) of 45%, negative predictive value (NPV) of 93%, and accuracy 76% (68 false positive and 15 false negative). Per-patient analysis had sensitivity 94%, specificity 55%, PPV 63%, NPV 92%, and accuracy 72% (30 false-positive and 3 false-negative). Inclusion of uninterpretable segments had variable effect on sensitivity and specificity, depending on whether they are considered as significant or non-significant stenosis. Conclusions: In patients with very extensive CAC (>1000 Agatston units), CCTA retained a negative predictive value > 90% to identify lack of significant stenosis on a per-vessel and per-patient level, but frequently overestimated stenosis.
KW - Accuracy
KW - Coronary artery calcium
KW - Coronary calcium score
KW - Coronary CT angiography
KW - Quantitative coronary angiography
KW - Stenosis
UR - https://www.scopus.com/pages/publications/85103261196
U2 - 10.1016/j.jcct.2021.03.007
DO - 10.1016/j.jcct.2021.03.007
M3 - Article
C2 - 33775584
AN - SCOPUS:85103261196
SN - 1934-5925
VL - 15
SP - 412
EP - 418
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
IS - 5
ER -