Comparison of Computed Tomography Coronary Angiography and Exercise ECG Test for Diagnostic Accuracy in Real-World Practice

Yun, Seongeun; Kang, Young Ran; Kim, Kyehwan; Choi, Young Min; Choi, Jungwoo; Koh, Jin-Sin; Park, Jeong Rang; Park, Yongwhi; Hwang, Seok-Jae; Jung, Young Hoon; Kwak, Choong Hwan; Choi, Hocheol; Jeon, Kyung Nyeo; Hwang, Jin-Yong

doi:2014.87.2.165

Korean J Med > Volume 87(2); 2014 > Article

Original Article

The Korean Journal of Medicine 2014;87(2):165-172.
Published online August 1, 2014.
DOI: https://doi.org/10.3904/kjm.2014.87.2.165

Comparison of Computed Tomography Coronary Angiography and Exercise ECG Test for Diagnostic Accuracy in Real-World Practice

Seongeun Yun^1*, Young Ran Kang^1*†, Kyehwan Kim¹, Young Min Choi¹, Jungwoo Choi¹, Jin-Sin Koh^1,3, Jeong Rang Park^1,3, Yongwhi Park^1,3, Seok-Jae Hwang^1,3, Young Hoon Jung^1,3, Choong Hwan Kwak^1,3, Hocheol Choi^2,3, Kyung Nyeo Jeon^2,3, Jin-Yong Hwang^1,3

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

관상동맥 컴퓨터 단층 촬영술과 운동부하 심전도 검사의 실제임상에서의 검사 정확도 비교

윤성은^1*, 강영란^1*†, 김계환¹, 최영민¹, 최정우¹, 고진신^1,3, 박정랑^1,3, 박용휘^1,3, 황석재^1,3, 정영훈^1,3, 곽충환^1,3, 최호철^2,3, 전경녀^2,3, 황진용^1,3

^¹경상대학교 의학전문대학원 내과학교실 순환기내과
^²경상대학교 의학전문대학원 영상진단학교실
^³경상대학교 건강과학연구원

Correspondence:
Jin-Yong Hwang, Tel: +82-55-750-8064, Fax: +82-55-758-9122, Email: jyhwang@gnu.ac.kr

Received: 7 January 2014 • Revised: 7 February 2014 • Accepted: 3 May 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.

Key Words: Computed tomography coronary angiography; Exercise ECG test; Coronary artery disease

주제어: 관상동맥 컴퓨터 단층 촬영술; 운동부하 심전도 검사; 관상동맥 질환