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.