title: Adjunctive value of CT coronary angiography in the diagnostic work-up of patients with typical angina pectoris.
abstract: OBJECTIVE
  To determine the adjunctive value of CT coronary angiography (CTCA) in the diagnostic work-up of patients with typical angina pectoris.
  
  
  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 beta-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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Erasmus Medical Center, Department of Cardiology, Room Ca-228a, Dr Molewaterplein 40, Rotterdam 3000CA, The Netherlands. n.mollet@erasmusmc.nl
authors.forename: Nico R
authors.initials: NR
authors.lastname: Mollet
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.forename: Carlos
authors.initials: C
authors.lastname: Van Mieghem
authors.forename: Bob
authors.initials: B
authors.lastname: Meijboom
authors.forename: Francesca
authors.initials: F
authors.lastname: Pugliese
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Runza
authors.forename: Timo
authors.initials: T
authors.lastname: Baks
authors.forename: Jolmer
authors.initials: J
authors.lastname: Dikkeboer
authors.forename: Eugene P
authors.initials: EP
authors.lastname: McFadden
authors.forename: Michel P
authors.initials: MP
authors.lastname: Freericks
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Kerker
authors.forename: Stieneke K
authors.initials: SK
authors.lastname: Zoet
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Gabriel P
authors.initials: GP
authors.lastname: Krestin
authors.forename: Pim J
authors.initials: PJ
authors.lastname: de Feyter
mesh_terms: D000787:Angina Pectoris / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014055:Tomography, Emission-Computed