Computed tomography coronary angiography vs. stress ECG in patients with stable angina.
OBJECTIVE
This study compared the role of multislice computed tomography coronary angiography (MSCT-CA) and stress electrocardiography (ECG) in the diagnostic workup of patients with chronic chest pain.


METHODS
MSCT-CA was performed in 43 patients (31 men, 12 women, mean age 58.8+/-7.7 years) with stable angina after a routine diagnostic workup involving stress ECG and conventional CA. The following inclusion criteria were adopted: sinus rhythm and ability to hold breath for 12 s. Beta-blockers were administered in patients with heart rate>or=70 beats/minute. In order to identify or exclude patients with significant stenoses (>or=50% lumen), we determined posttest likelihood ratios of stress test and MSCT-CA separately and of MSCT-CA performed after the stress test.


RESULTS
The pretest probability of significant coronary artery disease (CAD) was 74%. Positive and negative likelihood ratios were 2.3 [95% confidence interval (CI) 1.0-5.3] and 0.3 (95% CI: 0.2-0.7) for the stress test and 10.0 (95% CI: 1.8-78.4) and 0.0 (95% CI: 0.0-infinity) for MSCT-CA, respectively. MSCT-CA increased the posttest probability of significant CAD after a negative stress test from 50% to 86% and after a positive stress test from 88% to 100%. MSCT-CA correctly detected all patients without CAD.


CONCLUSIONS
Noninvasive MSCT-CA is a potentially useful tool in the diagnostic workup of patients with stable angina owing to its capability to detect or exclude significant CAD.
Cademartiri
F
F
Dipartimento di Radiologia e Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. filippocademartiri@hotmail.com
La Grutta
L
L
Palumbo
A
A
Maffei
E
E
Martini
C
C
Seitun
S
S
Coppolino
F
F
Belgrano
M
M
Malagò
R
R
Aldrovandi
A
A
Mollet
N
N
Weustink
A
A
Cova
M
M
Midiri
M
M
D000368:Aged; D000465:Algorithms; D000787:Angina Pectoris / Q000175:diagnosis* / Q000503:physiopathology; D017023:Coronary Angiography; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed