Positive predictive value of computed tomography coronary angiography in clinical practice
International Journal of Cardiology, 05/08/2012

Groothuis JGJ et al. – The positive predictive value (PPV) of computed tomography coronary angiography (CTCA) for detection of significant coronary artery disease (CAD) in patients with low to intermediate probability CAD that are clinically referred for non–invasive evaluation of chest pain is markedly lower than generally reported.

• A total of 181 patients with low to intermediate pre–test probability CAD that were referred for non–invasive evaluation of chest pain underwent 64–slice CTCA.
• CTCA was scored per segment as normal, non–obstructive CAD or obstructive CAD (>50% diameter stenosis).
• All patients with obstructive CAD according to CTCA, underwent ICA. Significant CAD was defined as >50% diameter stenosis on ICA.

• According to CTCA, 65 (35.9%) patients had obstructive CAD.
• In 26 (14.4%) patients, significant CAD was found by ICA.
• The PPV for detection of significant CAD per patient, per vessel and per segment were 40.0% (26/65, 95% CI: 30.6–50.2%), 31.3% (36/115, 95% CI: 24.7–38.8%) and 25.5% (42/165; 95% CI: 20.3–31.4%), respectively.