title: Multi-slice computed tomography: Can it adequately rule out left main coronary disease in patients with an intermediate probability of coronary artery disease?
abstract: BACKGROUND
  Multi-slice computed tomography (MSCT) is a fast-growing technology that permits a non-invasive, yet reliable, assessment of coronary atherosclerosis. We sought to explore the diagnostic accuracy of MSCT angiography in the detection of significant stenosis of the left main coronary artery (LMCA) in a series of patients with an intermediate pre-test likelihood of coronary artery disease (CAD).
  
  
  METHODS
  We prospectively enrolled 30 consecutive patients with an intermediate pre-test likelihood of CAD. Patients underwent 64-slice MSCT angiography to detect significant stenosis of the LMCA (defined as ≥ 50% luminal obstruction). They subsequently underwent invasive coronary angiography according to the standard technique.
  
  
  RESULTS
  The mean age was 52.7 ± 6.3 years, 24 (80%) being males. Three (10%) patients had significant stenosis of the LMCA by invasive coronary angiography, while four (13.3%) patients were categorized as having significant LMCA stenosis by MSCT coronary angiography. MSCT coronary angiography was able to detect significant LMCA stenosis with a sensitivity of 100%, specificity of 96.3%, positive and negative predictive values of 75% and 100% respectively, and a diagnostic accuracy of 96.7%, with reference to invasive coronary angiography.
  
  
  CONCLUSIONS
  In patients with an intermediate pre-test likelihood of CAD, MSCT coronary angiography provides a highly accurate diagnostic modality for ruling out significant LMCA stenosis, with reference to invasive coronary angiography.
authors.affiliation: Cardiology Deaprtment, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Salwa
authors.initials: S
authors.lastname: Swailam
authors.forename: Zainab
authors.initials: Z
authors.lastname: Abdel-Salam
authors.forename: Sameh
authors.initials: S
authors.lastname: Emil
authors.forename: Hazem
authors.initials: H
authors.lastname: Nabil
authors.forename: Wail
authors.initials: W
authors.lastname: Nammas
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D004534:Egypt; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed