In meta-analyses CTA has demonstrated a high diagnostic accuracy to identify patients with ≥50% stenoses by QCA, with a pooled AUC of 0.99. (1,2)   Multicenter studies yielded AUCs of 0.93 and 0.96 for 64-slice detector technology. (3-6) However, assessment of stenosis severity in individual<unk>  arterial lesions is more limited. In the study by Meijboom et al. (5) sensitivity for detecting ≥50% stenoses by QCA decreased from 99% on a patient level to 88% on a segment-based analysis and positive predictive value fell from 86% to 47%.
Using the presence or absence of obstructive and nonobstructive<unk>  artery disease, extensive data has accumulated demonstrating the prognostic information of CTA. Several studies examined the positive predictive value of CTA. (7,8)Bamberg et al report on the predictive value of the presence and the extent of CAD by CTA in their meta-analysis of 11 studies enrolling 7,335 patients. In patients with ≥1 significant<unk>  stenosis, annualized event rate (including revascularization) and hazard ratio were 11.9% and 10.74, respectively. (8)
More importantly, several studies demonstrate a low incidence of myocardial infarction or CAD-related death in patients after a normal CTA over a period of at least 2 years and possibly >5 years. (10-13)
In a meta-analysis of 9,592 patients from 17 studies, Hulten et al reported a sensitivity of 99% (95% CI 0.93-1.00, P < .001) to exclude adverse cardiovascular events at follow up. During the median follow-up period of 20 months, myocardial infarction or death occurred in 0.15% per year, which is comparable to healthy low-risk populations adjusted for age. (7) The CONFIRM international registry reported an annualized death rate of 0.28% after a normal CTA in 24,775 patients. (14)
Because of the high negative predictive value, CTA is suitable for clinical situations in which the exclusion of significant proximal disease is required.
-       Several studies describe the negative predictive value of CT in patient presenting to the ED with chest pain. (15-18)
-       This could include preoperative<unk>  evaluation before non-cardiac surgery.
Coronary computed tomography
Coronary angiography quantitative angiography
Coronary artery calcium scoring
Cardiac electrophysiology
Cardiovascular magnetic resonance imaging 
Quantitative coronary angiography
The left heart catheterization
Pulseless electrical activity echocardiography