Coronary Artery Disease: Sensitivity and Specificity

Introduction: See UpToDate page http://www.utdol.com/online/content/topic.do?topicKey=chd/59850 for good prevalence data and discussion. "Investigators from Duke confirmed that age, gender, and chest pain symptoms were the most powerful predictors of CHD, but showed that other characteristics also increase the probability of CHD. These included diabetes mellitus, which was the strongest predictor, smoking, hypercholesterolemia, and Q waves or ST-T changes on the resting ECG."

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Tags: Cardiac Problem Vascular Tag this Diagnosis.

Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Rate of CAD by age, gender, and type of chest pain	0%	http://www.utdol.com/online/content/topic.do?topicKey=chd/59850 (combined data from Diamond, GA, Forrester, JS, N Engl J Med 1979; 300:1350; and from Weiner, DA, Ryan, TJ, McCabe, CH, et al, N Engl J Med 1979; 301:230.)
Men with typical angina	89%	http://www.utdol.com/online/content/topic.do?topicKey=chd/59850 (from the Coronary Artery Surgery Study)
Women with typical angina	63%	http://www.utdol.com/online/content/topic.do?topicKey=chd/59850 (from the Coronary Artery Surgery Study)
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The sensitivity and specificity of findings for Coronary Artery Disease are listed below. See the left navigation bar to change the display.

Sensitive and Specific Findings

Cardiac CT
Duplicate

97.2%

87.4%

meta-analysis

Study: Ann Int Med vol. 152 no. 3 167-177 (2010)

http://www.annals.org/content/152/3/167.abstract?etoc

Specific Findings

Cardiac CT
Duplicate

80%

97%

Sensitivity is for >75% stenosis, but specificity is for >50% stenosis (!).

There is a lot of controversy surrounding this technique, especially as in imparts a great amount of radiation and is diagnostically limited in patients with significant coronary artery calcification. I believe this study is representative, but see UpToDate for more.

Study: J Am Coll Cardiol 2005 Jul 5;46(1):147-54. PMID 15992649

http://www.utdol.com/online/content/topic.do?topicKey=noninvas/16702#5

Stress Echocardiography

76%

88%

Study: Ann Intern Med 1999 May 4;130(9):719-28. PMID 10357690 (cited in UpToDate article)

Sensitive Findings

Finding	Sensitivity	Specificity	Comments, Study
PET/CT scan	91%	82%	Study: Ann Intern Med 1999 May 4;130(9):719-28. PMID 10357690 (cited in UpToDate article)
Nuclear Perfusion Duplicate	88%	77%	SPECT Study: Ann Intern Med 1999 May 4;130(9):719-28. PMID 10357690 (cited in UpToDate article)
Cardiac MRI	87.1%	70.3%	meta-analysis Study: Ann Int Med vol. 152 no. 3 167-177 (2010) http://www.annals.org/content/152/3/167.abstract?etoc

Poorly Diagnostic Findings

Exercise ECG

68%

77%

Full table from UpToDate: (amount of ST depression, sensitivity, specificity)

0.5 mm 80 60

1.0 mm 60 90

2.0 mm 20 98

Study: Circulation 1989 Jul;80(1):87-98. PMID 2661056

Nuclear Perfusion
Duplicate

79%

73%

planar Thallium

Study: Ann Intern Med 1999 May 4;130(9):719-28. PMID 10357690 (cited in UpToDate article)