Coronary computed tomography angiography after stress testing: Results from a multicenter, statewide registry, acic (advanced cardiovascular imaging consortium)

Kavitha M. Chinnaiyan, Gilbert L. Raff, Tauqir Goraya, Karthikeyan Ananthasubramaniam, Michael J. Gallagher, Aiden Abidov, Judith A. Boura, David Share, Patricia A. Peyser

Research output: Contribution to journalArticle

50 Scopus citations

Abstract

This study was conducted to evaluate the correlation between stress test results and coronary computed tomography angiography (CCTA) findings and comparative diagnostic performance of the 2 modalities in patients undergoing invasive coronary angiography (ICA). Background: Recent data suggest that only a third of patients undergoing ICA have obstructive coronary artery disease (CAD); accurate pre-ICA risk stratification is needed. Methods: At 47 centers participating in the ACIC (Advanced Cardiovascular Imaging Consortium) in Michigan, patients without known CAD who were undergoing CCTA within 3 months of a stress test were studied. Demographics, risk factors, symptoms, and stress test results were correlated with obstructive CAD (>50% stenosis) on CCTA and ICA. Results: Among 6,198 patients (age 56 ± 12 years, 48% men), >50% stenosis was seen in 1,158 (18.7%) on CCTA. Independent predictors included male sex (odds ratio [OR]: 2.37, 95% confidence interval [CI]: 1.83 to 3.06), current smoking (OR: 2.23, 95% CI: 1.57 to 3.17), older age (OR per 10-year increment: 2.14, 95% CI: 1.89 to 2.41), hypertension (OR: 1.8, 95% CI: 1.37 to 2.34), and typical angina (OR: 1.48, 95% CI: 1.03 to 2.12). Stress test results were not predictive. Among patients undergoing ICA (n = 621), there was a strong correlation of ICA with CCTA findings (OR: 9.09, 95% CI: 5.57 to 14.8, p < 0.001), but not stress results (OR: 0.79, 95% CI: 0.56 to 1.11, p = 0.17). Conclusions: Stress test findings did not predict obstructive CAD on CCTA, observed in <20% of patients in this large study group. The strong association of CCTA with ICA suggests that it may serve as an effective "gatekeeper" to invasive testing in patients needing adjudication of stress test results. (Advanced Cardiovascular Imaging Consortium: A Collaborative Quality Improvement Project [ACIC]; NCT00640068)

Original languageEnglish (US)
Pages (from-to)688-695
Number of pages8
JournalJournal of the American College of Cardiology
Volume59
Issue number7
DOIs
StatePublished - Feb 14 2012

Keywords

  • Advanced Cardiovascular Imaging Consortium
  • coronary computed tomography angiography
  • gatekeeper
  • stress tests

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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