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Accuracy of Noninvasive Coronary Angiography

Thanks to new imaging technologies, the coronary arteries now can be visualized noninvasively. In a German study of 103 patients with suspected coronary artery disease, researchers compared conventional invasive coronary angiography with multislice computed tomography (MSCT, using a scanner with 16 detector rows).

By invasive angiography, the prevalence of significant coronary disease (i.e., the proportion of patients with at least one stenosis >50%) was 56%. Each patient's coronary anatomy was divided into multiple segments. With segments as the unit of analysis, MSCT was 95% sensitive and 98% specific for detecting stenoses greater than 50%. With patients as the unit of analysis, the sensitivity, specificity, positive predictive value, and negative predictive value of MSCT were 97%, 87%, 90%, and 95%, respectively, for detecting patients with at least one stenosis greater than 50%.

Comment: In this study, MSCT performed quite well compared with invasive angiography. An editorialist describes current limitations of MSCT and how some of them might be overcome. Although the appropriate uses of MSCT remain to be determined, noninvasive coronary imaging likely will supplant conventional angiography — at least for some clinical indications — in the not-too-distant future.

— Allan S. Brett, MD

Published in Journal Watch General Medicine June 17, 2005

Citation(s):

Hoffmann MHK et al. Noninvasive coronary angiography with multislice computed tomography. JAMA 2005 May 25; 293:2471-8.

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• Medline abstract (Free)

Garcia MJ. Noninvasive coronary angiography: Hype or new paradigm? JAMA 2005 May 25; 293:2531-3.

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• Medline abstract (Free)