title: Stratification for noninvasive coronary angiography: patient preselection considering atypical angina pectoris, conventional cardiovascular risk assessment, and calcium scoring.
abstract: BACKGROUND
  Noninvasive coronary angiography (NCA) is recommended to be applied as a filter before invasive coronary angiography in patients with intermediate cardiovascular risk.
  
  
  METHODS
  In this prospective single-center study, we validated multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)-based NCA by primarily selecting patients with atypical angina pectoris (AAP).
  
  
  METHODS
  In 68 patients (63.6+/-11.4 years) with AAP, the Prospective Cardiovascular Muenster Study score and the Agatston score equivalent (ASE; calcium score) were initially determined for cardiovascular risk assessment. Subsequently, MSCT and MRI-based NCA were performed followed by quantitative invasive coronary angiography for validation. All tests were finally analyzed.
  
  
  RESULTS
  CAD (prevalence 38.2%) was diagnosed in 67.7% of patients at high, 61.5% at intermediate, and 37.8% at low cardiovascular risk according to the Prospective Cardiovascular Muenster Study. CAD was diagnosed in 88.2% of patients with an ASE >or=75th percentile and in 90.9% with an ASE >or=90th percentile. With regard to NCA, patient-based analysis resulted in a sensitivity of 96.2% for MSCT versus 69.2% for MRI, in a specificity of 95.2 versus 64.3%, in a positive predictive value of 97.6 versus 77.1%, in a negative predictive value of 92.6 versus 54.5%, and a diagnostic accuracy of 95.6 versus 66.2% (P<0.05).
  
  
  CONCLUSIONS
  In a patient group with a heterogeneous cardiovascular risk, primarily considering AAP allows for effective patient preselection for NCA. This may be optimized by precluding patients with an ASE >or=75th percentile. MSCT rather than MRI may then effectively be involved.
authors.affiliation: Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Germany. clanger@hdz-nrw.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Langer
authors.forename: Marcus
authors.initials: M
authors.lastname: Wiemer
authors.forename: Andreas
authors.initials: A
authors.lastname: Peterschröder
authors.forename: Krista
authors.initials: K
authors.lastname: Franzke
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Mellwig
authors.forename: Frank
authors.initials: F
authors.lastname: van Buuren
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Koester-Eiserfunke
authors.forename: Thomas
authors.initials: T
authors.lastname: Butz
authors.forename: Juergen
authors.initials: J
authors.lastname: Diekmann
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology* / Q000473:pathology; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000473:pathology; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed