Objectives: To determine the diagnostic performance and influencing factors of 128-slice coronary computed tomography angiography (CCTA) compared with invasive coronary angiography (ICA) in coronary artery disease (CAD) patients. 

Methods: A cross-sectional analysis study enrolled 139 patients suspected of CAD who underwent and received a 128-slice CCTA and invasive coronary angiography (ICA). 

Results: The patient-based model showed high sensitivity and positive predictive value (PPV) of 93.2% and 95.3%, respectively, for stenosis ≥ 50%. However, these values were lower when analyzed through vessel-based (85.6% and 81.1%) and segment-based (73.9% and 66.6%) models. Specificity and negative predictive value (NPV) were highest in the segment-based model, decreasing in the vessel-based and patient-based models at 96.4% and 95.4%; 90.5% and 90.0%; and 36.4% and 42.1%, respectively (for stenosis ≥ 70%). All diagnostic values reduced when the calcium score was ≥ 400 Agatston units. 

Conclusion: 128-slice CCTA demonstrates the optimal, minimally invasive, and high-performance method to diagnose the stenosis, and morphology of coronary artery lesions. The diagnostic performance of 128-slice CCTA was very highmostly ≥ 80%. The patient-based analysis and stenosis ≥ 50% had higher PPV and sensitivity values than vessel-based and stenosis ≥ 70%. Specificity and NPV were higher when analyzing smaller coronary segments. Heart rate and body mass index did not affect diagnostic accuracy, while a calcium score of ≥ 400 Agatston units was found to be a factor causing a decrease in diagnostic performance.

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