Adjunctive value of CT coronary angiography in the diagnostic work-up of patients with typical angina pectoris.
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.
Mollet
Nico R
NR
Erasmus Medical Center, Department of Cardiology, Room Ca-228a, Dr Molewaterplein 40, Rotterdam 3000CA, The Netherlands. n.mollet@erasmusmc.nl
Cademartiri
Filippo
F
Van Mieghem
Carlos
C
Meijboom
Bob
B
Pugliese
Francesca
F
Runza
Giuseppe
G
Baks
Timo
T
Dikkeboer
Jolmer
J
McFadden
Eugene P
EP
Freericks
Michel P
MP
Kerker
Jacques P
JP
Zoet
Stieneke K
SK
Boersma
Eric
E
Krestin
Gabriel P
GP
de Feyter
Pim J
PJ
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