Purpose: This study sought to evaluate the diagnostic accuracy of computed tomography coronary angiography (CTCA) for detecting significant coronary artery stenosis (≥50% lumen reduction) compared with conventional coronary angiography (CAG) in non-ST-elevation myocardial infarction-acute coronary syndrome (NSTEMI-ACS) and in subgroups selected by gender and number of risk factors (RF). Materials and methods: We selected from a population of 1,500 patients in a multicentre registry with NSTEMI-ACS who had undergone CTCA and CAG, (n=237; 187 men, mean age 63±10 years). Diagnostic accuracy and likelihood ratios (LR) of CTCA were assessed against CAG in the total population and subgroups (men, women: 0 RF = absence of RF, 1-2 RF = presence of one or two RF, >2 RF = presence of more than two RF). Results: The prevalence of obstructive disease was 53%. In the per-patient analysis, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CTCA were 100% (men 100%; women 100%; 0 RF 100%; 1-2 RF 100%; >2 RF 100%), 95% (men 98%; women 50%; 0 RF NA% (NA, not assessable); 1-2 RF 96%; >2 RF 96%), 95% (men 98%; women 91%; 0 RF 91%; 1-2 RF 96%; >2 RF 96%), 100% (men 100%; women 100%; 0 RF NV%; 1-2 RF 100%; >2 RF 100%), respectively. The per-segment analysis showed a reduction in PPV (ranging between 56% and 67%). The per-patient LR+ ranged between 18 and 27, whereas LR-were always 0. We observed no significant differences in diagnostic accuracy between subgroups. Conclusions: CTCA is a reliable diagnostic modality with high sensitivity and NPV in NSTEMI-ACS patients who are not candidates for early revascularisation, regardless of gender and number of risk factors.

Additional Metadata
Keywords Acute coronary syndrome, CT coronary angiography, Conventional coronary angiography, Diagnostic accuracy, NSTEMI, Registry, Risk factors
Persistent URL dx.doi.org/10.1007/s11547-011-0696-3, hdl.handle.net/1765/33276
Journal La Radiologia Medica
Maffei, E, Martini, C, Tedeschi, C, Spagnolo, P, Zuccarelli, A, Arcadi, T, … Cademartiri, F. (2011). Diagnostic accuracy of 64-slice computed tomography coronary angiography in a large population of patients without revascularisation: Registry data in NSTEMI acute coronary syndrome and influence of gender and risk factors. La Radiologia Medica, 116(7), 1014–1026. doi:10.1007/s11547-011-0696-3