Combined computed tomography angiography (CTA) and single photon emission computed tomography is not superior to CTA plus high-risk plaque assessment in predicting future cardiac events: Is it true?

摘要

Coronary computed tomography angiography (CTA) has emerged as a promising first-line test for detecting coronary artery disease (CAD) before proceeding to invasive coronary angiography (CAG). Many investigators have reported the advantage of its high negative predictive value. Therefore, CTA is an effective alternative to CAG for ruling out obstructive CAD. However, diagnostic accuracy depends on the pre-test probability in general. In patients with high pretest probability or known CAD, CTA is less effective for excluding obstructive CAD because the negative predictive value negatively correlates with the pre-test probability.3 In addition, relatively low positive predictive value brings about debate that borderline stenosis on CTA leads to many unnecessary invasive CAG, especially for patients with low pre-test probability. Additionally, some of these redundant CAG lead to fruitless coronary interventions.