On the Inappropriateness of Non-Invasive Multi-Detector Computed Tomography Coronary Angiography to Trigger off Coronary Revascularization: a comparison with Invasive Angiography

Sarno, Giovanna (2009) On the Inappropriateness of Non-Invasive Multi-Detector Computed Tomography Coronary Angiography to Trigger off Coronary Revascularization: a comparison with Invasive Angiography. [Tesi di dottorato] (Inedito)

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Abstract

Background Purpose of this prospective study was to evaluate the appropriateness of multi-detector computed tomography angiography (MDCTA) as anatomic standard for decision-making in patients with known or suspected coronary artery disease (CAD). Methods Pressure-derived fractional flow reserve (FFR) was obtained in 81 patients (116 vessels) who underwent both coronary angiogram (CA) and MDCTA. Segments were visually graded for stenosis severity as: G0 = normal, G1 = non-obstructive (<50% diameter reduction), G2 = obstructive (≥50% diameter reduction). Results The coronary segments assessed by visual scoring of disease severity were 334. Concordance between segmental severity scores by MDCTA and CA was good (k= 0.74; CI: 0.56 to 0.92). Diagnostic performance of MDCTA for detection of functionally significant stenosis based on FFR was low (sensitivity: 79%; specificity: 64%; positive likelihood ratio: 2.2; negative likelihood ratio: 0.3). Decision-making based on MDCTA would result in revascularization in the absence of ischemia in 22% of patients (18/81) and inappropriate deferral in 7% (6/81), while revascularization in the absence of ischemia would be 16% (13/81) and inappropriate deferral 12% (10/81) with decisions guided by CA. Combined evaluation of stenosis severity using both anatomy (with either CA or MDCTA) and function (with FFR) yields the highest proportion of appropriate decisions: 90 and 91% respectively (p=0.0001 vs CA only, p=0.0001 vs MDCTA only). Conclusions Similar to CA, anatomical assessment of coronary stenosis severity by MDCTA does not reliably predict its functional significance. These findings have important implications regarding the appropriateness of clinical decisions for revascularization.

Tipologia di documento:Tesi di dottorato
Parole chiave:computed tomography, coronary disease, revascularization
Settori scientifico-disciplinari MIUR:Area 06 Scienze mediche > MED/11 MALATTIE DELL'APPARATO CARDIOVASCOLARE
Coordinatori della Scuola di dottorato:
Coordinatore del Corso di dottoratoe-mail (se nota)
Marone, Gianni
Tutor della Scuola di dottorato:
Tutor del Corso di dottoratoe-mail (se nota)
Piscione, Federico
Stato del full text:Inedito
Data:12 Gennaio 2009
Numero di pagine:22
Istituzione:Università degli studi di Napoli "Federico II"
Dipartimento o Struttura:Cardiologia
Tipo di tesi:Dottorato
Stato dell'Eprint:Inedito
Scuola di dottorato:Fisiopatologia Clinica e Medicina Sperimentale
Denominazione del dottorato:Fisiopatologia Clinica e Medicina Sperimentale
Ciclo di dottorato:XXI
Numero di sistema:3446
Depositato il:17 Novembre 2009 16:39
Ultima modifica:17 Novembre 2009 16:39

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