Multislice CT vs. Invasive Angiography

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Summary and Comment

Multislice CT vs. Invasive Angiography

In a small study, multislice computed tomography had high sensitivity and specificity for predicting obstructive coronary artery disease, compared with gold-standard invasive coronary angiography.

Multislice computed tomography (MSCT) has been touted as a potential replacement for invasive coronary angiography, the gold standard. Researchers in Germany compared the diagnostic accuracy of 16-slice MSCT scanning with that of invasive angiography in 103 patients (mean age, 62) enrolled consecutively from November 2003 through August 2004. Most (88%) had suspected coronary artery disease (CAD); all had been referred for conventional angiography; and all underwent MSCT as part of the study.

Compared with angiography, MSCT performed well for detecting significant lumen narrowing (defined as >50% stenosis). MSCT's sensitivity, specificity, and positive and negative predictive values were 95%, 98%, 87%, and 99%, respectively, in a per-segment analysis and 97%, 87%, 90%, and 95%, respectively, in a per-patient analysis. Stenosis grading with MSCT versus standard angiography correlated significantly (r=0.87; P<0.001).

Comment: In this small study, multislice CT had high sensitivity and specificity for predicting obstructive CAD, compared with gold-standard invasive coronary angiography. An editorialist notes that if MSCT had been used initially, 40% of the subjects could have avoided unnecessary invasive angiography and 2% of subjects with significant CAD would have been missed. MSCT has limitations, including lower diagnostic accuracy in certain patients (e.g., those with extensive coronary calcification) and use of more radiation and contrast dye than are used in catheterization. Nevertheless, if these promising results are replicated in larger studies, they may support wider use of MSCT for CAD screening. For now, MSCT is neither widely available nor standardized.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology June 24, 2005