Document Type : Original research
University of Kirkuk - College of Medicine
Background: Emerging as a major cause of death and disability in the developing countries is coronary artery disease (CAD). Traditional coronary angiography has traditionally been the preferred diagnostic procedure for CAD. Non-invasive evaluation of coronary artery disease (CAD) using computed tomography (CT) coronary angiography shows promise. This observational study's goal is to assess the relative efficacy of noninvasive multi-section computed tomography (MSCT) coronary angiography vs invasive selective coronary angiography in detecting coronary stenosis.
Method and patient: This observational study carried out in the Azadi teaching Hospital/Kirkuk between November 2021 to March 2022. Patients who suspected to have coronary artery disease underwent both CTCA and invasive coronary angiography in different centers in our country comparing and analyzing their results.
Result: In total, 92 participants were enrolled in the trial. Patients had a mean age of 57.207.3 years, and men made up the vast majority of those who appeared (67.3 percent). Chest pain was the most common presenting complaint (94 percent). Patients exhibited a prevalence of 84% for HTN, 55% for hyperlipidaemia, 58% for diabetes, and 4% for ischemic heart disease. In addition, 50% of the patients are either current or former smokers. Half of the patients received 64-slice CT scans, nearly half had 128-slice scans, and 3.2% got 256-slice scans. CCTA's sensitivity was 100%, and its specificity was 66.7%. Positive predictive value for CCTA was 98.8 percent (meaning it correctly identified positive cases in 98.8 percent of patients) and negative predictive value was 100 percent, for a total diagnostic accuracy of 98.9 percent (which mean CCTA can exclude all negative cases and did not miss any case). When looking at individual arteries, the LAD artery was shown to be the most accurate, while the LCX artery was the least accurate (95.6 percent and 78.2 percent respectively). In terms of sensitivity, LAD performed at a 99.1% rate, while LMS performed at a 0% rate (33.3 percent). RCA had the most specificity (95.2 percent), whereas LAD had the lowest (88.8 percent) (40 percent). In order to determine what factors, influence CCTA positivity, we performed a binary logistic regression analysis for positive CCTA (negative as reference) with all variables from the studies. The results showed that IHD, lesions in the LAD artery, lesions in the LCX artery, and CT slice thickness (128 and 256 slices) all have a negative effect on CCTA (p0.05).
Conclusions: When compared to traditional angiography, multi-slice computed tomography has demonstrated superior sensitivity and specificity for the identification of coronary artery disease.