Diagnostic Performance of Computed Tomography Coronary Angiography (from the Prospective National Multicenter Multivendor EVASCAN Study)
Diagnostic Performance of Computed Tomography Coronary Angiography (from the Prospective National Multicenter Multivendor EVASCAN Study)
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DOI：
10.1016/j.amjcard.2012.10.029
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发表时间：
2013-02-15
影响因子：
2.8
通讯作者：
Laissy, Jean-Pierre
中科院分区：
文献类型：
--
作者：
Gueret, Pascal;Deux, Jean-Francois;Laissy, Jean-Pierre
计算机断层冠状动脉造影术（CTCA）已被提议作为一种无创性的测试显着的冠状动脉疾病（CAD），但只有有限的数据是从前瞻性多中心试验。本研究的目的是在具有冠状动脉成像临床指征的大量症状性患者中，确定CTCA与冠状动脉造影（CA）相比的诊断准确性。这项全国性多中心研究旨在前瞻性评价能够接受CTCA后常规CA的稳定患者。在中心核心实验室以设盲方式分析CTCA和CA的数据。主要结局是评价CTCA基于患者、血管和节段的诊断性能，以检测或排除显著CAD（管腔直径减小>= 50%）。757例患者入组，746（平均年龄61 - 12岁，71%的男性）进行了分析。他们接受了CTCA，然后在1.7 +/- 0.8天后使用64探测器扫描仪进行CA。通过CA，自体冠状动脉血管中显著CAD的患病率为54%。CTCA无法评估的节段率为6%。在基于患者的分析中，CTCA的敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比分别为91%、50%、68%、83%、1.82和0.18。CTCA假阴性结果的最强预测因素是CAD的高估计预测概率（比值比[OR] 1.97，p
Computed tomographic coronary angiography (CTCA) has been proposed as a noninvasive test for significant coronary artery disease (CAD), but only limited data are available from prospective multicenter trials. The goal of this study was to establish the diagnostic accuracy of CTCA compared to coronary angiography (CA) in a large population of symptomatic patients with clinical indications for coronary imaging. This national, multicenter study was designed to prospectively evaluate stable patients able to undergo CTCA followed by conventional CA. Data from CTCA and CA were analyzed in a blinded fashion at central core laboratories. The main outcome was the evaluation of patient-, vessel-, and segment-based diagnostic performance of CTCA to detect or rule out significant CAD (>= 50% luminal diameter reduction). Of 757 patients enrolled, 746 (mean age 61 12 years, 71% men) were analyzed. They underwent CTCA followed by CA 1.7 +/- 0.8 days later using a 64-detector scanner. The prevalence of significant CAD in native coronary vessels by CA was 54%. The rate of nonassessable segments by CTCA was 6%. In a patient-based analysis, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of CTCA were 91%, 50%, 68%, 83%, 1.82, and 0.18, respectively. The strongest predictors of false-negative results on CTCA were high estimated pretest probability of CAD (odds ratio [OR] 1.97, p