관상동맥 컴퓨터 단층 촬영술과 운동부하 심전도 검사의 실제임상에서의 검사 정확도 비교

Abstract

Background/Aims: The exercise ECG test (XECG) and computed tomography coronary angiography (CTCA) have been usedwidely in initial evaluations of coronary artery disease (CAD) in real-world practice. In this study, we compared the diagnosticpower 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 theevaluation of CAD in outpatient clinics. Significant stenosis was defined as more than 50% diameter stenosis. Triage to CCA and/orrevascularization 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 detectedon CCA. Also, 65 (11%) patients underwent RT. In the CTCA results, 120 patients had significant stenosis. Of them, 58 (48%) and75 (62%) patients were triaged to RT and CCA, respectively. Based on the XECG, 115 positive patients were triaged to RT andCCA (23 [20%]/41 [35%]). Among 107 patients with CCA, the sensitivity, specificity, positive predictive value, and negativ epredictive 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 andXECG was 0.145 (p = 0.113). Conclusions: In real-world practice, CCA was decided on more frequently, based on CTCA. CTCA showed better diagnosticaccuracy than XECG.