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Korean J Med > Volume 87(2); 2014 > Article
The Korean Journal of Medicine 2014;87(2): 165-172.
관상동맥 컴퓨터 단층 촬영술과 운동부하 심전도 검사의 실제임상에서의 검사 정확도 비교
윤성은1*, 강영란1*†, 김계환1, 최영민1, 최정우1, 고진신1,3, 박정랑1,3, 박용휘1,3, 황석재1,3, 정영훈1,3, 곽충환1,3, 최호철2,3, 전경녀2,3, 황진용1,3
1경상대학교 의학전문대학원 내과학교실 순환기내과
2경상대학교 의학전문대학원 영상진단학교실
3경상대학교 건강과학연구원
Comparison of Computed Tomography Coronary Angiography and Exercise ECG Test for Diagnostic Accuracy in Real-World Practice
Seongeun Yun1*, Young Ran Kang1*†, Kyehwan Kim1, Young Min Choi1, Jungwoo Choi1, Jin-Sin Koh1,3, Jeong Rang Park1,3, Yongwhi Park1,3, Seok-Jae Hwang1,3, Young Hoon Jung1,3, Choong Hwan Kwak1,3, Hocheol Choi2,3, Kyung Nyeo Jeon2,3, Jin-Yong Hwang1,3
1Division of Cardiology, Departments of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
2Division of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
3Institute of Health Science, Gyeongsang National University, Jinju, Korea
Corresponding Author: Jin-Yong Hwang ,Tel: +82-55-750-8064, Fax: +82-55-758-9122, Email: jyhwang@gnu.ac.kr
Received: January 7, 2014;   Revised: February 7, 2014;   Accepted: May 3, 2014.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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 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.
Keywords: Computed tomography coronary angiography; Exercise ECG test; Coronary artery disease
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