title: Usefulness of 64-slice multidetector computed tomography in diagnostic triage of patients with chest pain and negative or nondiagnostic exercise treadmill test result.
abstract: The usefulness of 64-slice multidetector coronary computed tomography (MDCT) in a diagnostic triage of 100 consecutive patients (age 55.8+/-11.6 years; 57% men) with chest pain suspected to be ischemic in origin and a negative or nondiagnostic exercise treadmill test (ETT) result was examined. None of the patients had previously known coronary artery disease (CAD). MDCT showed obstructive (>or=50%) CAD in 29 patients; 13 of 59 patients (22%) with a negative and 16 of 41 patients (39%) with a nondiagnostic ETT result. High-risk (left main and/or 3-vessel) CAD was present in 3.3% of patients with a negative and 4.9% with a nondiagnostic ETT result. The 29 patients with obstructive CAD on MDCT had a higher mean Agatston calcium score (221+/-402 vs 40+/-77 U, p<0.001). Invasive coronary angiography confirmed MDCT findings in 26 of 29 patients (positive predictive value 90%) and 45 of 54 stenotic segments (83%) in a per-segment analysis. For the 71 patients without obstructive CAD on MDCT, clinically driven invasive angiography detected CAD in 1 of 15 patients (1 false-negative MDCT result) and 2 of another 5 patients who were referred for invasive angiography later during a 12-month follow-up period. In the remaining 51 patients, MDCT findings effectively allowed exclusion of obstructive CAD, and there were no major adverse clinical events during follow-up. In conclusion, in patients with chest pain possibly ischemic in origin, no previously known CAD, and a negative or nondiagnostic ETT result, contrast-enhanced 64-slice MDCT scanning was a useful tool to provide direct noninvasive coronary angiography and rapidly advance diagnostic triage.
authors.affiliation: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Ronen
authors.initials: R
authors.lastname: Rubinshtein
authors.forename: David A
authors.initials: DA
authors.lastname: Halon
authors.forename: Tamar
authors.initials: T
authors.lastname: Gaspar
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Schliamser
authors.forename: Nisan
authors.initials: N
authors.lastname: Yaniv
authors.forename: Ronny
authors.initials: R
authors.lastname: Ammar
authors.forename: Moshe Y
authors.initials: MY
authors.lastname: Flugelman
authors.forename: Nathan
authors.initials: N
authors.lastname: Peled
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D002114:Calcinosis / Q000000981:diagnostic imaging; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D005080:Exercise Test; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014218:Triage