Comparison of Computed Tomography Coronary Angiography and Exercise ECG Test for Diagnostic Accuracy in Real-World Practice.
10.3904/kjm.2014.87.2.165
- Author:
Seongeun YUN
1
;
Young Ran KANG
;
Kyehwan KIM
;
Young Min CHOI
;
Jungwoo CHOI
;
Jin Sin KOH
;
Jeong Rang PARK
;
Yongwhi PARK
;
Seok Jae HWANG
;
Young Hoon JUNG
;
Choong Hwan KWAK
;
Hocheol CHOI
;
Kyung Nyeo JEON
;
Jin Yong HWANG
Author Information
1. Division of Cardiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Gyeongsang National University, Jinju, Korea. jyhwang@gnu.ac.kr
- Publication Type:Original Article
- Keywords:
Computed tomography coronary angiography;
Exercise ECG test;
Coronary artery disease
- MeSH:
Ambulatory Care Facilities;
Constriction, Pathologic;
Coronary Angiography*;
Coronary Artery Disease;
Electrocardiography*;
Humans;
Retrospective Studies;
Sensitivity and Specificity;
Triage
- From:Korean Journal of Medicine
2014;87(2):165-172
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: The exercise ECG test (XECG) and computed tomography coronary angiography (CTCA) have been used widely in initial evaluations of coronary artery disease (CAD) in real-world practice. In this study, we compared the diagnostic power of CTCA and XECG, based on conventional coronary angiography (CCA). METHODS: We enrolled 589 consecutive patients retrospectively who had been examined with both XECG and CTCA for the evaluation of CAD in outpatient clinics. Significant stenosis was defined as more than 50% diameter stenosis. Triage to CCA and/or revascularization treatment (RT) by the results of XECG and CTCA and the diagnostic accuracy of both exams, based on CCA, were investigated. RESULTS: In the 589 patients, 107 (19%) were triaged to CCA for further evaluation; in 77 (12.8%) significant stenosis was detected on CCA. Also, 65 (11%) patients underwent RT. In the CTCA results, 120 patients had significant stenosis. Of them, 58 (48%) and 75 (62%) patients were triaged to RT and CCA, respectively. Based on the XECG, 115 positive patients were triaged to RT and CCA (23 [20%]/41 [35%]). Among 107 patients with CCA, the sensitivity, specificity, positive predictive value, and negative predictive value for significant stenosis on CCA of CTCA were 89.9%, 74.0%, 90.6%, and 71.4%, respectively, and those of XECG were 50.0, 67.9, 78.0, and 37.3, respectively. The kappa value of CCA and CTCA was 0.62 (p < 0.001) and that of CCA and XECG was 0.145 (p = 0.113). CONCLUSIONS: In real-world practice, CCA was decided on more frequently, based on CTCA. CTCA showed better diagnostic accuracy than XECG.
