Objectives: To determine the diagnostic performance of CT coronary angiography (CTCA) in detecting and excluding left main (LM) and/or three-vessel CAD ("high-risk" CAD) in symptomatic patients and to compare its discriminatory value with the Duke risk score and calcium score. Materials and methods: Between 2004 and 2011, a total of 1,159 symptomatic patients (61 ± 11 years, 31 % women) with stable angina, without prior revascularisation underwent both invasive coronary angiography (ICA) and CTCA. All patients gave written informed consent for the additional CTCA. High-risk CAD was defined as LM and/or three-vessel obstructive CAD (≥50 % diameter stenosis). Results: A total of 197 (17 %) patients had high-risk CAD as determined by ICA. The sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios of CTCA were 95 % (95 % CI 91-97 %), 83 % (80-85 %), 53 % (48-58 %), 99 % (98-99 %), 5.47 and 0.06, respectively. CTCA provided incremental value (AUC 0.90, P < 0.001) in the discrimination of high-risk CAD compared with the Duke risk score and calcium score. Conclusions: CTCA accurately excludes high-risk CAD in symptomatic patients. The detection of high-risk CAD is suboptimal owing to the high percentage (47 %) of overestimation of high-risk CAD. CTCA provides incremental value in the discrimination of high-risk CAD compared with the Duke risk score and calcium score.

Additional Metadata
Keywords "High-risk" CAD, Calcium score, coronary calcification, Computed tomography coronary angiography, Diagnostic performance, Duke risk score, clinical evaluation, Left main and/or three-vessel CAD
Persistent URL dx.doi.org/10.1007/s00330-013-2935-6, hdl.handle.net/1765/66652
Journal European Radiology: journal of the European Congress of Radiology
Citation
Dharampal, A.S, Papadopoulou, S.L, Rossi, A, Meijboom, W.B, Weustink, A.C, Dijkshoorn, M.L, … Krestin, G.P. (2013). Diagnostic performance of computed tomography coronary angiography to detect and exclude left main and/or three-vessel coronary artery disease. European Radiology: journal of the European Congress of Radiology, 23(11), 2934–2943. doi:10.1007/s00330-013-2935-6