title: Computed tomography versus exercise electrocardiography in patients with stable chest complaints: real-world experiences from a fast-track chest pain clinic.
abstract: OBJECTIVE
  To compare the diagnostic performance of CT angiography (CTA) and exercise electrocardiography (XECG) in a symptomatic population with a low-intermediate prevalence of coronary artery disease (CAD).
  
  
  METHODS
  Prospective registry.
  
  
  METHODS
  Tertiary university hospital.
  
  
  METHODS
  471 consecutive ambulatory patients with stable chest pain complaints, mean (SD) age 56 (10), female 227 (48%), pre-test probability for significant CAD >5%.
  
  
  METHODS
  All patients were intended to undergo both 64-slice, dual-source CTA and an XECG. Clinically driven quantitative catheter angiography was performed in 98 patients.
  
  
  METHODS
  Feasibility and interpretability of, and association between, CTA and XECG, and their diagnostic performance with invasive coronary angiography as reference.
  
  
  RESULTS
  CTA and XECG could not be performed in 16 (3.4%) vs 48 (10.2%, p<0.001), and produced non-diagnostic results in 3 (0.7%) vs 140 (33%, p<0.001). CTA showed > or =1 coronary stenosis (> or =50%) in 140 patients (30%), XECG was abnormal in 93 patients (33%). Results by CTA and XECG matched for 185 patients (68%, p = 0.63). Catheter angiography showed obstructive CAD in 57/98 patients (58%). Sensitivity, specificity, positive and negative predictive value of CTA to identify patients with > or =50% stenosis was 96%, 37%, 67% and 88%, respectively; compared with XECG: 71%, 76%, 80% and 66%, respectively. Quantitative CTA slightly overestimated diameter stenosis: 6 (21)% (R = 0.71), compared with QCA. Of the 312 patients (66%) with a negative CTA, 44 (14%) had a positive XECG, but only 2/17 who underwent catheter angiography had significant CAD.
  
  
  CONCLUSIONS
  CTA is feasible and diagnostic in more patients than XECG. For interpretable studies, CTA has a higher sensitivity, but lower specificity for detection of CAD.
authors.affiliation: Erasmus Medical Centre, Thoraxcenter Bd 434, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. Koennieman@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Nieman
authors.forename: T
authors.initials: T
authors.lastname: Galema
authors.forename: A
authors.initials: A
authors.lastname: Weustink
authors.forename: L
authors.initials: L
authors.lastname: Neefjes
authors.forename: A
authors.initials: A
authors.lastname: Moelker
authors.forename: P
authors.initials: P
authors.lastname: Musters
authors.forename: R
authors.initials: R
authors.lastname: de Visser
authors.forename: N
authors.initials: N
authors.lastname: Mollet
authors.forename: H
authors.initials: H
authors.lastname: Boersma
authors.forename: P J
authors.initials: PJ
authors.lastname: de Feijter
mesh_terms: D002637:Chest Pain / Q000209:etiology*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D004562:Electrocardiography / Q000379:methods; D005080:Exercise Test / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics; D011446:Prospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*