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Study confirms diagnostic accuracy of combined CT angiography and perfusion 

CORE 320

Topics: Non-invasive imaging: Echocardiography, MR/CT, Nuclear
Date: 29 Aug 2012
COMBINING non-invasive CT angiography (CTA) with myocardial perfusion imaging (CTP) has robust diagnostic accuracy for identifying patients with flow-limiting coronary stenoses in need of myocardial revascularisation, according to the CORE320 study presented yesterday.

Joao Lima:  presented CORE 320  results.

Commenting on the findings, principal investigator Joao Lima, from the Johns Hopkins Hospital, Baltimore, USA, said: “We found the addition of CT myocardial perfusion to CT angiography allows clinicians to distinguish between anatomic and flow limiting stenoses in patients with suspected coronary disease.”
CORE320 was a prospective multi-centre international trial which evaluated the diagnostic accuracy of combined non-invasive CTA and CTP as compared with invasive angiography (ICA) and single photon computed tomography myocardial perfusion imaging (SPECT-MPI). 
Investigators enrolled patients at 16 centres in eight countries, and 381 participants successfully completed all imaging. The age range was between 45 and 85 years, and 60% were male.
Patients had a history of risk factors for CAD - 34% were diabetic, 26% had a history of previous myocardial infarction, 29% had prior PCI, 78% were positive for hypertension, 68% were positive for dislipidemia, and 45% had a family history of CAD.
The study design included four imaging components: CTA, stress CTP, ICA, and SPECT-MPI.
Results from the study found that the prevalence of obstructive coronary artery disease defined by combined ICA and SPECT/MPI was 38%, and 59% for ICA alone.
The patient-based diagnostic accuracy (AUC) of combined CTA and CTP for detecting or excluding flow-limiting CAD was 0.87 (95% CI 0.83-0.91), and 0.89 (95% CI 0.86-0.93) when the ICA stenosis reference standards were >50% and >70% respectively. 
CTP increased the diagnostic accuracy of CTA alone to delineate flow-limiting disease (AUC 0.87 vs 0.81, p<0.001).
The combination of CTA and CTP had similar diagnostic power to the combination of ICA and SPECT-MPI in identifying revascularised patients at 30-days.