title: Coronary CT angiography in clinical triage of patients at high risk of coronary artery disease.
abstract: OBJECTIVE
  To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients at high risk of coronary artery disease.
  
  
  METHODS
  The diagnostic value of 64-detector CCTA was evaluated in 400 patients presenting with non-ST segment elevation myocardial infarction using invasive coronary angiography (ICA) as the reference method. The relation between the severity of disease by CCTA and a combined endpoint of death, re-hospitalization due to new myocardial infarction, or symptom-driven coronary revascularization was assessed.
  
  
  RESULTS
  CCTA detects significant (>50%) coronary artery diameter stenosis with a sensitivity, specificity, and positive and negative predictive value of 99%, 81%, 96% and 95%, respectively. CCTA was used to triage patients into guideline defined treatment groups of "no or medical treatment", "referral to percutaneous coronary intervention" or to "coronary artery bypass graft surgery" and was compared to the index ICA. CCTA correctly triaged patients in 86% of cases. During a median follow-up of 50 months, the presence of an occluded artery by CCTA was associated with adverse outcome.
  
  
  CONCLUSIONS
  CCTA has high diagnostic and prognostic value in patients with high likelihood of coronary artery disease and could, in theory, be used to triage high risk patients. As many obstacles remain, including logistical and safety issues, our study does not support the use of CCTA as an additional diagnostic test before ICA in an all-comer NSTEMI population.
authors.affiliation: a Department of Cardiology , Heart Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
authors.forename: J Tobias
authors.initials: JT
authors.lastname: Kühl
authors.affiliation: b Department of Cardiology , Hvidovre Hospital, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Jens D
authors.initials: JD
authors.lastname: Hove
authors.affiliation: c Department of Radiology , Diagnostic Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Kristensen
authors.affiliation: a Department of Cardiology , Heart Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Jakob B
authors.initials: JB
authors.lastname: Norsk
authors.affiliation: a Department of Cardiology , Heart Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.affiliation: a Department of Cardiology , Heart Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: d Department of Cardiology , Roskilde Sygehus , Roskilde, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.affiliation: a Department of Cardiology , Heart Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.|c Department of Radiology , Diagnostic Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Kofoed
mesh_terms: D000368:Aged; D016507:Cardiology Service, Hospital; D002317:Cardiovascular Agents / Q000627:therapeutic use; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D014218:Triage
chemical_list: D002317:Cardiovascular Agents
keywords: Coronary computed tomography angiography; acute coronary syndrome; diagnostic accuracy; myocardial infarct; prognosis