Objectives: We assessed the usefulness of 64-slice computed tomography coronary angiography (CTCA) to detect or rule out coronary artery disease (CAD) in patients with various estimated pretest probabilities of CAD. Background: The pretest probability of the presence of CAD may impact the diagnostic performance of CTCA. Methods: Sixty-four-slice CTCA (Sensation 64, Siemens, Forchheim, Germany) was performed in 254 symptomatic patients. Patients with heart rates ≥65 beats/min received beta-blockers before CTCA. The pretest probability for significant CAD was estimated by type of chest discomfort, age, gender, and traditional risk factors and defined as high (≥71%), intermediate (31% to 70%), and low (≤30%). Significant CAD was defined as the presence of at least 1 ≥50% coronary stenosis on quantitative coronary angiography, which was the standard of reference. No coronary segments were excluded from analysis. Results: The estimated pretest probability of CAD in the high (n = 105), intermediate (n = 83), and low (n = 66) groups was 87%, 53%, and 13%, respectively. The diagnostic performance of the computed tomography (CT) scan was different in the 3 subgroups. The estimated post-test probability of the presence of significant CAD after a negative CT scan was 17%, 0%, and 0% and after a positive CT scan was 96%, 88%, and 68%, respectively. Conclusions: Computed tomography coronary angiography is useful in symptomatic patients with a low or intermediate estimated pretest probability of having significant CAD, and a negative CT scan reliably rules out the presence of significant CAD. Computed tomography coronary angiography does not provide additional relevant diagnostic information in symptomatic patients with a high estimated pretest probability of CAD.

doi.org/10.1016/j.jacc.2007.07.007, hdl.handle.net/1765/36173
Journal of the American College of Cardiology
Erasmus MC: University Medical Center Rotterdam

Meijboom, W. B., van Mieghem, C., Mollet, N., Pugliese, F., Weustink, A., van Pelt, N., … de Feyter, P. (2007). 64-Slice Computed Tomography Coronary Angiography in Patients With High, Intermediate, or Low Pretest Probability of Significant Coronary Artery Disease. Journal of the American College of Cardiology, 50(15), 1469–1475. doi:10.1016/j.jacc.2007.07.007