Korean J Med.
2014 Aug;87(2):165-172. 10.3904/kjm.2014.87.2.165.
Comparison of Computed Tomography Coronary Angiography and Exercise ECG Test for Diagnostic Accuracy in Real-World Practice
- Affiliations
-
- 1Division of Cardiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Gyeongsang National University, Jinju, Korea. jyhwang@gnu.ac.kr
- 2Departments of Internal Medicine, and Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Gyeongsang National University, Jinju, Korea.
- 3Institute of Health Science, Gyeongsang National University, Jinju, Korea.
- KMID: 1710026
- DOI: http://doi.org/10.3904/kjm.2014.87.2.165
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.
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