CARLOS EDUARDO ROCHITTE

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/64, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 74 Citação(ões) na Scopus
    Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging versus Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events: The CORE320 Multicenter Study
    (2017) CHEN, Marcus Y.; ROCHITTE, Carlos E.; ARBAB-ZADEH, Armin; DEWEY, Marc; GEORGE, Richard T.; MILLER, Julie M.; NIINUMA, Hiroyuki; YOSHIOKA, Kunihiro; KITAGAWA, Kakuya; SAKUMA, Hajime; LAHAM, Roger; VAVERE, Andrea L.; CERCI, Rodrigo J.; MEHRA, Vishal C.; NOMURA, Cesar; KOFOED, Klaus F.; JINZAKI, Masahiro; KURIBAYASHI, Sachio; SCHOLTE, Arthur J.; LAULE, Michael; TAN, Swee Yaw; HOE, John; PAUL, Narinder; RYBICKI, Frank J.; BRINKER, Jeffrey A.; ARAI, Andrew E.; MATHESON, Matthew B.; COX, Christopher; CLOUSE, Melvin E.; CARLI, Marcelo F. Di; LIMA, Joao A. C.
    Purpose: To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial perfusion imaging. Materials and Methods: This study was approved by all institutional review boards, and written informed consent was obtained. Between November 2009 and July 2011, 381 participants clinically referred for ICA and aged 45-85 years were enrolled in the Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) prospective multicenter diagnostic study. All images were analyzed in blinded independent core laboratories, and a panel of physicians adjudicated all adverse events. MACE was defined as revascularization (>.30 days after index ICA), myocardial infarction, or cardiac death; hospitalization for chest pain or congestive heart failure; or arrhythmia. Late MACE was defined similarly, except for patients who underwent revascularization within the first 182 days after ICA, who were excluded. Comparisons of 2-year survival (time to MACE) used standard Kaplan- Meier curves and restricted mean survival times bootstrapped with 2000 replicates. Results: An MACE (49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia) occurred in 51 of 379 patients (13.5%). The 2-year MACE-free rates for combined CT angiography and CT perfusion findings were 94% negative for coronary artery disease (CAD) versus 82% positive for CAD and were similar to combined ICA and single photon emission CT findings (93% negative for CAD vs 77% positive for CAD, P < .001 for both). Event-free rates for CT angiography and CT perfusion versus ICA and single photon emission CT for either positive or negative results were not significantly different for MACE or late MACE (P > .05 for all). The area under the receiver operating characteristic curve (AUC) for combined CT angiography and CT perfusion (AUC = 68; 95% confidence interval [CI]: 62, 75) was similar (P = .36) to that for combined ICA and single photon emission CT (AUC = 71; 95% CI: 65, 79) in the identification of MACE at 2-year follow-up. Conclusion: Combined CT angiography and CT perfusion enables similar prediction of 2-year MACE, late MACE, and event-free survival similar to that enabled by ICA and single photon emission CT. (C) RSNA, 2017
  • article 42 Citação(ões) na Scopus
    Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia. A systematic review and meta-analysis
    (2016) SORGAARD, Mathias Holm; KOFOED, Klaus Fuglsang; LINDE, Jesper James; GEORGE, Richard Thomas; ROCHITTE, Carlos Eduardo; FEUCHTNER, Gudrun; LIMA, Joao A. C.; ABDULLA, Jawdat
    Objectives: The aim of this study is to provide a meta-analysis of all published studies assessing the diagnostic accuracy of stress CT myocardial perfusion imaging (CTP) in patients suspected of or with known coronary artery disease. This analysis is limited to static stress CTP. Methods: Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography with and without fractional flow reserve (FFR). Results: The search revealed 19 eligible studies including 1188 patients. Pooled results showed that CTP had a good agreement with SPECT and MRP. On a per-patient level, sensitivity, specificity and AUC were 0.85 (95% CI: 0.70-0.93), 0.81 (95% CI: 0.59-0.93), 0.90 (95% CI: 0.87-0.92). On a per-artery level, sensitivity, specificity and AUC were 0.80 (95% CI: 0.67-0.88), 0.81 (95% CI: 0.72-0.88) and 0.87 (95% CI: 0.84-0.90). When invasive coronary angiography was used as reference standard, combined coronary CTA and CTP compared to coronary CTA alone significantly improved the specificity from 0.62 (95% CI: 0.52-0.70) to 0.84 (95% CI: 0.74-0.91) on a per-patient level (p = 0.008) and from 0.72 (95% CI: 0.63-0.79) to 0.90 (95% CI: 0.85-0.93) on a per-artery level (p = 0.0001) without significant decrease in sensitivity (p = 0.59 and p = 0.23, respectively). Conclusion: In selected patients, static CT myocardial perfusion has high diagnostic accuracy to detecting myocardial ischemia. Specificity increases significantly when CT myocardial perfusion is combined with coronary CFA.
  • article 123 Citação(ões) na Scopus
    Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data
    (2019) HAASE, Robert; SCHLATTMANN, Peter; GUERET, Pascal; ANDREINI, Daniele; PONTONE, Gianluca; ALKADHI, Hatem; HAUSLEITER, Joerg; GARCIA, Mario J.; LESCHKA, Sebastian; MEIJBOOM, Willem B.; ZIMMERMANN, Elke; GERBER, Bernhard; SCHOEPF, U. Joseph; SHABESTARI, Abbas A.; NORGAARD, Bjarne L.; MEIJS, Matthijs F. L.; SATO, Akira; OVREHUS, Kristian A.; DIEDERICHSEN, Axel C. P.; JENKINS, Shona M. M.; KNUUTI, Juhani; HAMDAN, Ashraf; HALVORSEN, Bjorn A.; MENDOZA-RODRIGUEZ, Vladimir; ROCHITTE, Carlos E.; RIXE, Johannes; WAN, Yung Liang; LANGER, Christoph; BETTENCOURT, Nuno; MARTUSCELLI, Eugenio; GHOSTINE, Said; BUECHEL, Ronny R.; NIKOLAOU, Konstantin; MICKLEY, Hans; YANG, Lin; ZHANG, Zhaqoi; CHEN, Marcus Y.; HALON, David A.; RIEF, Matthias; SUN, Kai; HIRT-MOCH, Beatrice; NIINUMA, Hiroyuki; MARCUS, Roy P.; MURAGLIA, Simone; JAKAMY, Reda; CHOW, Benjamin J.; KAUFMANN, Philipp A.; TARDIF, Jean-Claude; NOMURA, Cesar; KOFOED, Klaus F.; LAISSY, Jean-Pierre; ARBAB-ZADEH, Armin; KITAGAWA, Kakuya; LAHAM, Roger; JINZAKI, Masahiro; HOE, John; RYBICKI, Frank J.; SCHOLTE, Arthur; PAUL, Narinder; TAN, Swee Y.; YOSHIOKA, Kunihiro; ROEHLE, Robert; SCHUETZ, Georg M.; SCHUELER, Sabine; COENEN, Maria H.; WIESKE, Viktoria; ACHENBACH, Stephan; BUDOFF, Matthew J.; LAULE, Michael; NEWBY, David E.; DEWEY, Marc
    OBJECTIVE To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. DESIGN Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. DATA SOURCES Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2x2 or 3x2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. RESULTS Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v 0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 v all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)). CONCLUSIONS In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients.
  • conferenceObject
    Accuracy of Coronary Artery Calcium Scanning for Detecting Obstructive Coronary Artery Disease in Patients With Normal Nuclear Myocardial Perfusion Imaging
    (2018) BAKHSHI, Hooman; MEYGHANI, Zahra; MATHESON, Matthew; SHARMA, Garima; KOFOED, Klaus; TAN, Swee Y.; GEORGE, Richard T.; CARLI, Marcelo Di; MILLER, Julie; COX, Christopher; ROCHITTE, Carlos; LIMA, Joao A.; ZADEH, Armin A.
  • article 0 Citação(ões) na Scopus
    Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset (vol 28, pg 4006, 2018)
    (2018) ROEHLE, Robert; WIESKE, Viktoria; SCHUETZ, Georg M.; GUERET, Pascal; ANDREINI, Daniele; MEIJBOOM, Willem Bob; PONTONE, Gianluca; GARCIA, Mario; ALKADHI, Hatem; HONORIS, Lily; HAUSLEITER, Joerg; BETTENCOURT, Nuno; ZIMMERMANN, Elke; LESCHKA, Sebastian; GERBER, Bernhard; ROCHITTE, Carlos; SCHOEPF, U. Joseph; SHABESTARI, Abbas Arjmand; NORGAARD, Bjarne; SATO, Akira; KNUUTI, Juhani; MEIJS, Matthijs F. L.; BRODOEFEL, Harald; JENKINS, Shona M. M.; OVREHUS, Kristian Altern; DIEDERICHSEN, Axel Cosmus Pyndt; HAMDAN, Ashraf; HALVORSEN, Bjorn Arild; RODRIGUEZ, Vladimir Mendoza; WAN, Yung Liang; RIXE, Johannes; SHEIKH, Mehraj; LANGER, Christoph; GHOSTINE, Said; MARTUSCELLI, Eugenio; NIINUMA, Hiroyuki; SCHOLTE, Arthur; NIKOLAOU, Konstantin; ULIMOEN, Geir; ZHANG, Zhaoqi; MICKLEY, Hans; NIEMAN, Koen; KAUFMANN, Philipp A.; BUECHEL, Ronny Ralf; HERZOG, Bernhard A.; CLOUSE, Melvin; HALON, David A.; LEIPSIC, Jonathan; BUSH, David; JAKAMY, Reda; SUN, Kai; YANG, Lin; JOHNSON, Thorsten; LAISSY, Jean-Pierre; MARCUS, Roy; MURAGLIA, Simone; TARDIF, Jean-Claude; CHOW, Benjamin; PAUL, Narinder; MAINTZ, David; HOE, John; ROOS, Albert de; HAASE, Robert; LAULE, Michael; SCHLATTMANN, Peter; DEWEY, Marc
  • conferenceObject
    Prognostic value of noninvasive combined anatomic/functional assessment by cardiac ct in patients with suspected coronary heart disease
    (2020) DEWEY, M.; ROCHITTE, C.; OSTOVANEH, M.; CHEN, M.; GEORGE, R. T.; NIINUMA, H.; KITAGAWA, K.; LAHAM, R.; KOFOED, K.; NOMURA, C.; SAKUMA, H.; YOSHIOKA, K.; MEHRA, V; JINZAKI, M.; ARBAB-ZADEH, A.
  • article 43 Citação(ões) na Scopus
    Ischemia and No Obstructive Stenosis (INOCA) at CT Angiography, CT Myocardial Perfusion, Invasive Coronary Angiography, and SPECT: The CORE320 Study
    (2020) SCHUIJF, Joanne D.; MATHESON, Matthew B.; OSTOVANEH, Mohammad R.; ARBAB-ZADEH, Armin; KOFOED, Klaus F.; SCHOLTE, Arthur J. H. A.; DEWEY, Marc; STEVESON, Chloe; ROCHITTE, Carlos E.; YOSHIOKA, Kunihiro; COX, Christopher; CARLI, Marcelo F. Di; LIMA, Joao A. C.
    Background: CT allows evaluation of atherosclerosis, coronary stenosis, and myocardial ischemia. Data on the characterization of ischemia and no obstructive stenosis (INOCA) at CT remain limited. Purpose: This was an observational study to describe the prevalence of INOCA defined at coronary CT angiography with CT perfusion imaging and associated clinical and atherosclerotic characteristics. The analysis was also performed for the combination of invasive coronary angiography (ICA) and SPECT as a secondary aim. Materials and Methods: The prospective CORE320 study (ClinicalTrials.gov: NCT00934037) enrolled participants between November 2009 and July 2011 who were symptomatic and referred for clinically indicated ICA. Participants underwent CT angiography, rest-adenosinestress CT perfusion, and rest-stress SPECT prior to ICA. For this ancillary study, the following three phenotypes were considered, using either CT angiography/CT perfusion or ICA/SPECT data: (a) participants with obstructive (>= 50%) stenosis, (b) participants with no obstructive stenosis but ischemia (ie, INOCA) on the basis of abnormal perfusion imaging results, and (c) participants with no obstructive stenosis and normal perfusion imaging results. Clinical characteristics and CT angiography athero-scleroticplaque measures were compared by using the Pearson chi(2) or Wilcoxon rank-sum test. Results: A total of 381 participants (mean age, 62 years [interquartile range, 56-68 years]; 129 [34%] women) were evaluated. A total of 31 (27%) of 115 participants without obstructive (>= 50%) stenosis at CT angiography had abnormal CT perfusion findings. The corresponding value for ICA/SPECT was 45 (30%) of 151. The prevalence of INOCA was 31 (8%) of 381 (95% confidence interval [CI]: 5%, 11%) with CT angiography/CT perfusion and 45 (12%) of 381 (95% CI: 9%, 15%) with ICA/SPECT. Participants with CT-defined INOCA had greater total atheroma volume (118 vs 60 mm(3), P =.008), more positive remodeling (13% vs 1%, P =.006), and greater low-attenuation atheroma volume (20 vs 10 mm(3), P =.007) than participants with no obstructive stenosis and no ischemia. Comparisons for ICA/SPECT showed similar trends. Conclusion: In CORE320, ischemia and no obstructivestenosis (INOCA) prevalence was 8% and 12% at CT angiography/CT perfusion and invasive coronary angiography/SPECT, respectively. Participants with INOCA had greater atherosclerotic burden and more adverse plaque features at CT compared with those with no obstructive stenosis and no ischemia. (C) RSNA, 2019
  • article 28 Citação(ões) na Scopus
    Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification: The CORE320 study
    (2015) SHARMA, Ravi K.; ARBAB-ZADEH, Armin; KISHI, Satoru; CHEN, Marcus Y.; MAGALHAES, Tiago A.; GEORGE, Richard T.; DEWEY, Marc; RYBICKI, Frank J.; KOFOED, Klaus F.; ROOS, Albert de; TAN, Swee Yaw; MATHESON, Matthew; VAVERE, Andrea; COX, Christopher; CLOUSE, Melvin E.; MILLER, Julie M.; BRINKER, Jeffery A.; ARAI, Andrew E.; CARLI, Marcelo F. Di; ROCHITTE, Carlos E.; LIMA, Joao A. C.
    Background: Myocardial CT perfusion (CTP) has been validated as an incremental diagnostic predictor over coronary computed tomography angiography (CTA) in assessing hemodynamically significant stenosis. Objectives: To assess the diagnostic performance of CTA and CTP alone versus combined CTA-CTP stratified by Morise's pre-test probability and coronary artery calcium (CAC, Agatston) score. Methods: 381 individuals (153 low/intermediate-risk for CAD, 83 high-risk, 145 known CAD) were further stratified based on CAC score cut-offs of 1-399 and >= 400. Area under the curve for receiver operating characteristics (AUC) was calculated to assess the diagnostic performance. Reference standards were QCA >= 50% stenosis + corresponding SPECT summed stress score >= 1. Results: In both pre-test risk groups with an Agatston score of 1-399, AUCs of CTA-CTP were not significantly different than that from CTA alone. In the low/intermediate-risk group with CAC score 1-399, AUC for CTA-CTP (89) was higher than that for CTP (76, p = 0.003) alone. In the same group with CAC score = 400, AUCs were higher for CTA-CTP (97) than that for CTA (88, p = 0.030) and CTP (83, p = 0.033). In high risk/known CAD patients with CAC 1-399, diagnostic performance for CTA-CTP (77) was superior to CTP (71, p = 0.037) alone. In the high risk/known CAD group with CAC score = 400, AUCs for combined imaging were higher (86) than that for CTA (75, p < 0.001) as well as CTP (78, p = 0.020). Conclusions: The incremental diagnostic accuracy of CTP over CTA persists in patients across severity spectra of pre-test probability of CAD and coronary artery calcification. In patients with severe coronary calcification (CAC score = 400), combined CTA-CTP has better diagnostic accuracy than CTA and CTP alone.
  • article 25 Citação(ões) na Scopus
    Coronary Calcium Characteristics as Predictors of Major Adverse Cardiac Events in Symptomatic Patients: Insights From the CORE320 Multinational Study
    (2019) LO-KIOENG-SHIOE, Mallory S.; VAVERE, Andrea L.; ARBAB-ZADEH, Armin; SCHUIJF, Joanne D.; ROCHITTE, Carlos E.; CHEN, Marcus Y.; RIEF, Matthias; KOFOED, Klaus F.; CLOUSE, Melvin E.; SCHOLTE, Arthur J.; MILLER, Julie M.; BETOKO, Aisha; BLAHA, Michael J.; COX, Christopher; DECKERS, Jaap W.; LIMA, Joao A. C.
    Background-The predictive value of coronary artery calcium (CAC) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results-A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast-enhanced images. The primary outcome of 2-year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4%). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56-68) years, 34% were women, and 56% were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions-In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.
  • article 106 Citação(ões) na Scopus
    Myocardial CT Perfusion Imaging and SPEC T for the Diagnosis of Coronary Artery Disease: A Head-to-Head Comparison from the CORE320 Multicenter Diagnostic Performance Study
    (2014) GEORGE, Richard T.; MEHRA, Vishal C.; CHEN, Marcus Y.; KITAGAWA, Kakuya; ARBAB-ZADEH, Armin; MILLER, Julie M.; MATHESON, Matthew B.; VAVERE, Andrea L.; KOFOED, Klaus F.; ROCHITTE, Carlos E.; DEWEY, Marc; YAW, Tan S.; NIINUMA, Hiroyuki; BRENNER, Winfried; COX, Christopher; CLOUSE, Melvin E.; LIMA, Joao A. C.; CARLI, Marcelo Di
    Purpose: To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography. Materials and Methods: This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (A(z)). Sensitivity and specificity were calculated with use of prespecified cutoffs. The reference standard was a stenosis of at least 50% at coronary angiography as determined with quantitative methods. Results: CAD was diagnosed in 229 of the 381 patients (60%). The per-patient sensitivity and specificity for the diagnosis of CAD (stenosis. 50%) were 88% (202 of 229 patients) and 55% (83 of 152 patients), respectively, for CT perfusion imaging and 62% (143 of 229 patients) and 67% (102 of 152 patients) for SPECT, with A(z) values of 0.78 (95% confidence interval: 0.74, 0.82) and 0.69 (95% confidence interval: 0.64, 0.74) (P =.001). The sensitivity of CT perfusion imaging for single-and multivessel CAD was higher than that of SPECT, with sensitivities for left main, three-vessel, two-vessel, and one-vessel disease of 92%, 92%, 89%, and 83%, respectively, for CT perfusion imaging and 75%, 79%, 68%, and 41%, respectively, for SPECT. Conclusion: The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis. 50%), as demonstrated with the A(z), was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease. (C) RSNA, 2014