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

Circ Cardiovasc Interv. 2013 Jun;6(3):262-8. doi: 10.1161/CIRCINTERVENTIONS.112.000205. Epub 2013 May 21.


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.

Keywords: coronary angiography; coronary artery; diagnosis; pathology.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Area Under Curve
  • Coronary Angiography*
  • Coronary Stenosis / diagnosis*
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / pathology
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / pathology*
  • Humans
  • Japan
  • Predictive Value of Tests
  • ROC Curve
  • Severity of Illness Index