Characteristics of patients with a significant stenosis in a conventional coronary angiogram with a normal multi-detector computed tomographic coronary angiogram.
Multi-detector computed tomography (MDCT) has high diagnostic value for detecting or excluding coronary artery stenosis. However, conventional coronary angiograms (CCA) are occasionally required in patients having persistent chest pain with normal MDCT. We retrospectively analyzed 90 patients who underwent CCA due to persistent chest pain with normal MDCT. The patients were classified into patients having more than 50% diameter stenosis in CCA (false negative, group I: n = 14, 62.6 +/- 7.5 years, 7 males) and those having less than 50% diameter stenosis (true negative, group II: n = 76, 52.1 +/- 12.0 years, 42 males). Significant stenosis was observed in 9 patients at the left anterior descending artery, 4 at the right coronary artery, and 1 at the left circumflex artery in group I. Group I patients were older than group II patients (63 +/- 8 versus 52 +/- 12 years, P < 0.001). There were more patients with hypertension and smoking in group I (64.3% versus 7.9%, 35.7% versus 3.9%, P < 0.001, P < 0.001, respectively). The levels of uric acid and homocysteine were higher in group I than in group II (5.7 +/- 1.5 versus 4.6 +/- 1.2 mg/dL, 9.6 +/- 3.1 versus 7.4 +/- 2.5 mol/L, P = 0.008, P = 0.010, respectively). There were more ST or T changes in the electrocardiograms in group I (35.7% versus 1.3%) (P < 0.001). In multivariate analysis, a history of hypertension, uric acid levels, and ischemic evidence in the electrocardiogram were independent factors for a false negative of MDCT (odds ratio 11.11, 4.76, 1.81, 95% confidence interval 4.67 to 10.00, 1.41 to 1.61, 1.05 to 3.33, P = 0.009, P = 0.012, P = 0.046, respectively). In certain situations, the findings of coronary stenosis by MDCT do not always correlate with that of CCA.
Jeong
Hae Chang
HC
The Heart Center of Chonnam National University Hospital, Cardiovascular Research Institute of Chonnam National University, Gwangju, Republic of Korea.
Ahn
Youngkeun
Y
Jeong
Myung Ho
MH
Chung
Jong Won
JW
Cho
Jung Sun
JS
Shim
Du Sun
du S
Yoon
Nam Sik
NS
Moon
Jae Yeun
JY
Kim
Kye Hun
KH
Park
Hyung Wook
HW
Hong
Young Joon
YJ
Kim
Ju Han
JH
Cho
Jeong Gwan
JG
Park
Jong Chun
JC
D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*