Assessment of coronary artery stenosis by coronary angiography: a head-to-head comparison with pathological coronary artery anatomy.

BACKGROUND Conventional coronary angiography (CCA) has been considered as a gold standard for the diagnosis of coronary artery diseases; however, its diagnostic accuracy is still unknown. METHODS AND RESULTS Between July 2004 and December 2011, 97 patients underwent CCA within 15 days before heart transplantation in Fuwai hospital. A head-to-head comparison study was performed to examine the diagnostic accuracy of CCA as compared with that of pathological coronary artery anatomy. As confirmed by pathological coronary artery anatomy, 44 (45.4%) patients had coronary artery diseases. The patient-based diagnostic accuracy evaluation showed that the area under the receiver-operating characteristic curve of CCA for detecting ≥50% stenosis was 0.91, with a sensitivity of 91%, a specificity of 93%, and high concordance (κ=0.83). A per-vessel analysis of 291 vessels yielded an AUC of 0.79, the agreement of 3 vessels >0.6 (κ statistic). The area under the receiver-operating characteristic curve was 0.88 for proximal and middle segments, and was 0.62 for distal segments, κ was calculated to detect the distal segments with lower concordance than proximal and middle segments. The patient- and vessel-based evaluations showed similar diagnostic accuracy of CCA in detecting ≥75% stenosis. Per-segment evaluation found CCA was more accurate for detecting ≥50% and ≥75% stenosis in proximal and middle segments than in distal segments, and the diagnosis ability decreased in more severe stenosis segments and more complex lesions. CONCLUSIONS The accuracy of CCA is quite high in detecting coronary artery stenosis in patients- and vessels-based levels. However, the diagnosis ability decreased in more severe and complex lesions, especially for distal segments.