Limited clinical utility of CT coronary angiography in a district hospital setting

Jenkins, S.M.M. et al. (2011) Limited clinical utility of CT coronary angiography in a district hospital setting. QJM: An International Journal of Medicine, 104(1), pp. 49-57. (doi: 10.1093/qjmed/hcq163)

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Background: Studies have demonstrated considerable accuracy of multi-slice CT coronary angiography (MSCT-CA) in comparison to invasive coronary angiography (I-CA) for evaluating coronary artery disease (CAD). The extent to which published MSCT-CA accuracy parameters are transferable to routine practice beyond high-volume tertiary centres is unknown. Aim: To determine the accuracy of MSCT-CA for the detection of CAD in a Scottish district general hospital. Design: Prospective study of diagnostic accuracy. Method: One hundred patients with suspected CAD recruited from two Glasgow hospitals underwent both MSCT-CA (Philips Brilliance 40 × 0.625 collimation, 50–200 ms temporal resolution) and I-CA. Studies were reported by independent, blinded radiologists and cardiologists and compared using the AHA 15-segment model. Results: Of 100 patients [55 male, 45 female, mean (SD) age 58.0 (10.7) years], 59 and 41% had low-intermediate and high pre-test probabilities of significant CAD, respectively. Mean (SD) heart rate during MSCT-CA was 68.8 (9.0) bpm. Fifty-seven per cent of patients had coronary artery calcification and 35% were obese. Patient prevalence of CAD was 38%. Per-patient sensitivity, specificity, positive and negative (NPV) predictive values for MSCT-CA were 92.1, 47.5, 52.2 and 90.6%, respectively. NPV was reduced to 75.0% in the high pre-test probability group. Specificity was compromised in patients with sub-optimally controlled heart rates, calcified arteries and elevated BMI. Conclusion: Forty-Slice MSCT-CA has a high NPV for ruling out significant CAD when performed in a district hospital setting in patients with low-intermediate pre-test probability and minimal arterial calcification. Specificity is compromised by clinically appropriate strategies for dealing with unevaluable studies. Effective heart rate control during MSCT-CA is imperative. National guidelines should be utilized to govern patient selection and direct MSCT-CA reporter training to ensure quality control.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Messow, Dr Martina and McConnachie, Professor Alex
Authors: Jenkins, S.M.M., Johnston, N., Hawkins, N.M., Messow, C.-M., Shand, J., Hogg, K.J., Eteiba, H., McKillop, G., Goodfield, N.E.R., McConnachie, A., and Dunn, F.G.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:QJM: An International Journal of Medicine
Journal Abbr.:QJM
Publisher:Oxford University Press
ISSN (Online):1460-2393
Published Online:16 September 2010

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