CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease.
OBJECTIVE
To evaluate diagnostic accuracy of exercise ECG (ex-ECG) versus 64-slice CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis in a population with low-to-intermediate pre-test likelihood of coronary artery disease (CAD).


METHODS
Retrospective single centre.


METHODS
Tertiary academic hospital.


METHODS
177 consecutive patients (88 men, 89 women, mean age 53.5±7.6 years) with chest pain and low-to-intermediate pre-test likelihood of CAD were retrospectively enrolled.


METHODS
All patients underwent ex-ECG, CT-CA and invasive coronary angiography (ICA).


METHODS
A lumen diameter reduction of ≥50% was considered as significant stenosis for CT-CA. Ex-ECG was classified as positive, negative or non-diagnostic.


RESULTS
were compared with ICA. Diagnostic accuracy of CT-CA and ex-ECG was calculated using ICA as the reference standard. A parallel comparative analysis using a cut-off value of 70% for significant lumen reduction was also performed too. Results ICA disclosed an absence of significant stenosis (≥50% luminal narrowing) in 85.3% (151/177) patients, single-vessel disease in 9.0% (16/177) patients and multivessel disease in 5.6% (10/177) patients. Prevalence of obstructive disease at ICA was 14.7% (26/177). Sensitivity, specificity, positive and negative predictive values at the patient level were 100.0%, 98.7%, 92.9%, 100%, respectively, for CT-CA and 46.2%, 16.6%, 8.7%, 64.1%, respectively, for ex-ECG. Agreement between CT-CA and ex-ECG was 20.9%. CT-CA performed equally well in men and women, while ex-ECG had a better performance in men. After considering the cut-off value of 70% for significant stenosis, the difference between CT-CA and ex-ECG remained significant (p<0.01), with a low agreement (21.5%).


CONCLUSIONS
CT-CA provides optimal diagnostic performance in patients with atypical chest pain and low-to-intermediate risk of CAD. Ex-ECG has poor diagnostic accuracy in this population. Concerns are related to risk of radiation dose versus the benefits of correct disease stratification.
Department of Radiology and Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy.
Erica
E
Maffei
Sara
S
Seitun
Chiara
C
Martini
Alessandro
A
Palumbo
Giuseppe
G
Tarantini
Elena
E
Berti
Roberto
R
Grilli
Carlo
C
Tedeschi
Giancarlo
G
Messalli
Andrea
A
Guaricci
Annick C
AC
Weustink
Nico Ra
NR
Mollet
Filippo
F
Cademartiri
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000209:etiology*; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult