Adjunctive value of CT coronary angiography in the diagnostic work-up of patients with typical angina pectoris
Aims: To determine the adjunctive value of CT coronary angiography (CTCA) in the diagnostic work-up of patients with typical angina pectoris. Methods and results: CTCA was performed in 62 consecutive patients (45 male, mean age 58.8 ± 7.7 years) with typical angina undergoing diagnostic work-up including exercise-ECG and conventional coronary angiography. Only patients with sinus heart rhythm and ability to breath hold for 20 s were included. Patients with initial heart rates ≥70 beats/min received β-blockers. We determined the post-test likelihood ratios, to detect or exclude patients with significant (≥50% lumen diameter reduction) stenoses, of exercise-ECG and CTCA separately, and of CT performed after exercise-ECG testing. The prevalence of patients with significant coronary artery disease (CAD) was 74%. Positive and negative likelihood ratios for exercise-ECG were 2.3 [95% confidence interval (CI): 1.0-5.3] and 0.3 (95% CI: 0.2-0.7) and for CTCA 7.5 (95% CI: 2.1-27.1) and 0.0 (95% CI: 0.0-8), respectively. CTCA increased the post-test probability of significant CAD after a negative exercise-ECG from 58 to 91%, and after a positive exercise-ECG from 89 to 99%, while CT correctly identified patients without CAD (probability 0%). Conclusion: Non-invasive CTCA is a potentially useful tool, in the diagnostic work-up of patients with typical angina pectoris, both to detect and to exclude significant CAD.
|Keywords||Computed tomography, Coronary angiography, Coronary artery disease, Exercise-ECG test, Imaging|
|Persistent URL||dx.doi.org/10.1093/eurheartj/ehl563, hdl.handle.net/1765/35764|
Mollet, N.R.A., Cademartiri, F., van Mieghem, C.A.G., Meijboom, B.W., Pugliese, F., Runza, G., … de Feyter, P.J.. (2007). Adjunctive value of CT coronary angiography in the diagnostic work-up of patients with typical angina pectoris. European Heart Journal, 28(15), 1872–1878. doi:10.1093/eurheartj/ehl563