Triage of patients with suspected coronary artery disease using multislice computed tomography.
OBJECTIVE
Several studies have shown that multislice computed tomography (MSCT) has a high sensitivity and specificity for detecting coronary artery stenoses. The aim of the present study was to investigate whether MSCT can reliably triage patients with suspected coronary artery disease (CAD) to coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or no revascularization.


METHODS
A total of 123 patients with suspected CAD who were referred for conventional coronary angiography (CATH) additionally underwent MSCT (16*0.5 mm detector collimation). Therapeutic decisions made on the basis of CATH and MSCT strictly following current guidelines for treatment of CAD were compared with decisions made by a cardiac surgeon and an interventional cardiologist. Only MSCTs with at least adequate image quality in all coronary segments were included in the analysis (94/123).


RESULTS
Decisions made on the basis of MSCT and CATH according to guidelines did not differ significantly (agreement of 88%, 82 of 94, P = .319). The therapeutic decisions made by the interventional cardiologist and the cardiac surgeon based on CATH differed significantly (overall agreement of 79%, 74 of 94 cases, P < .001; cardiologist: 78% PCI and 22% CABG versus surgeon: 38% PCI and 62% CABG), whereas there was 100% agreement regarding decisions for or against invasive treatment.


CONCLUSIONS
MSCT shows good agreement with CATH in triaging patients with suspected CAD to CABG, PCI, or no revascularization. The choice of revascularization procedure is significantly more strongly influenced by whether an interventional cardiologist or a cardiac surgeon makes the decision than by the diagnostic test on which the decision is based.
Department of Radiology, Charité, Humboldt University Medical School, Berlin, Germany.
Hans
H
Hoffmann
Hans-Peter
HP
Dübel
Horst
H
Laube
Bernd
B
Hamm
Marc
M
Dewey
D015906:Angioplasty, Balloon, Coronary; D002114:Calcinosis / Q000175:diagnosis / Q000000981:diagnostic imaging; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007603:Jurisprudence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed