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KMID : 0882420140870020165
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Korean Journal of Medicine
2014 Volume.87 No. 2 p.165 ~ p.0
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Comparison of Computed Tomography Coronary Angiography and Exercise ECG Test for Diagnostic Accuracy in Real-World Practice
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Yun Seong-Eun
Kang Young-Ran
Kim Kye-Hwan
Choi Young-Min
Choi Jung-Woo
Koh Jin-Sin
Park Jeong-Rang
Park Yong-Whi
Hwang Seok-Jae
Jeong Young-Hoon
Kwak Choong-Hwan
Choi Ho-Cheol
Jeon Kyung-Nyeo
Hwang Jin-Yong
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Abstract
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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).
Method: 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 negativ e 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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KEYWORD
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Computed tomography coronary angiography, Exercise ECG test, Coronary artery disease
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