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CT angiography for evaluation of coronary artery disease in inner-city outpatients: an initial prospective comparison with stress myocardial perfusion imaging

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Abstract

To evaluate the utility of CT coronary angiography (CTA) for demonstrating coronary artery disease in inner-city outpatients, we prospectively compared CTA with stress SPECT myocardial perfusion imaging in an ethnically diverse, gender balanced population. All patients gave written informed consent for this IRB approved, HIPAA compliant study. Sixty-one patients completed both CTA and SPECT. About 67% were ethnic minorities, 51% were women. A stenosis of ≥70% on CTA was considered positive. Results were compared with perfusion defects on SPECT and correlated with clinical endpoints (hospital admissions, cardiovascular events, coronary interventions and deaths). CTA and SPECT data were compared with results of coronary angiography, when performed. There was moderate global agreement of 79% (48/61) between CTA and SPECT, κ = 0.483 (SE ± 0.13, P = 0.0001). With SPECT as the reference standard, CTA had sensitivity of 73% (11/15), specificity of 80% (37/46), negative predictive value of 90% (37/41) and positive predictive value of 55% (11/20). Positive SPECT was associated with positive CTA, (P < 0.0001, OR = 22). Eleven (18%) underwent subsequent cardiac catheterization, which was positive in 91% (10/11). CTA and SPECT had positive predictive values of 90 and 83% compared with catheterization. This study lends preliminary evidence to support to the utility of CTA as an alternative modality for the evaluation of CAD in an ethnically diverse, gender balanced inner-city outpatient population. Similar to more homogenous groups, CTA had a high negative predictive value and demonstrated disease occult to SPECT. Further study is necessary to evaluate the impact of CTA on patient outcomes.

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Acknowledgments

This research protocol could not have been completed without the help of a large and dedicated team. We thank Menachem M. Gold, MD, Calvin Lo, MD and Divya Malhotra, MD for their valuable contributions in preparing the IRB proposal and the patient informed consent. We thank Eric Wasp, PA, Zehra Ahmed, PA and Melanie Aure, PA for their assistance in expediting the care of patients participating in this research protocol. We thank Steven Sheh, Rebecca Altschul, Brian Chou, Martha Gomez and Charadin Frank for their assistance in patient recruitment. We thank Alpesh Mehta for obtaining patient follow-up. We thank Jonathan N. Tobin, PhD and Sylvia Wassertheil-Smoller, PhD for their assistance with study design. Supported in-part by a research grant from GE Healthcare.

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Authors and Affiliations

  1. Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East-210th Street, Bronx, NY, 10467-2490, USA

    Linda B. Haramati, Jeffrey M. Levsky, Vineet R. Jain & Hugo Spindola-Franco

  2. Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Erik J. Altman, Shalini Bobra, Sanjay Doddamani & Mark I. Travin

  3. Department of Nuclear Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Mark I. Travin

Authors
  1. Linda B. Haramati
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  2. Jeffrey M. Levsky
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  8. Mark I. Travin
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Correspondence to Linda B. Haramati.

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Haramati, L.B., Levsky, J.M., Jain, V.R. et al. CT angiography for evaluation of coronary artery disease in inner-city outpatients: an initial prospective comparison with stress myocardial perfusion imaging. Int J Cardiovasc Imaging 25, 303–313 (2009). https://doi.org/10.1007/s10554-008-9382-5

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  • DOI: https://doi.org/10.1007/s10554-008-9382-5

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