Head-to-head comparison of the diagnostic performance of coronary computed tomography angiography and dobutamine-stress echocardiography in the evaluation of acute chest pain with normal ECG findings and negative troponin tests: A prospective multicenter study.
OBJECTIVE
To perform a head-to-head comparison of coronary CT angiography (CCTA) and dobutamine-stress echocardiography (DSE) in patients presenting recent chest pain when troponin and ECG are negative.


METHODS
Two hundred seventeen patients with recent chest pain, normal ECG findings, and negative troponin were prospectively included in this multicenter study and were scheduled for CCTA and DSE. Invasive coronary angiography (ICA), was performed in patients when either DSE or CCTA was considered positive or when both were non-contributive or in case of recurrent chest pain during 6month follow-up. The presence of coronary artery stenosis was defined as a luminal obstruction >50% diameter in any coronary segment at ICA.


RESULTS
ICA was performed in 75 (34.6%) patients. Coronary artery stenosis was identified in 37 (17%) patients. For CCTA, the sensitivity was 96.9% (95% CI 83.4-99.9), specificity 48.3% (29.4-67.5), positive likelihood ratio 2.06 (95% CI 1.36-3.11), and negative likelihood ratio 0.07 (95% CI 0.01-0.52). The sensitivity of DSE was 51.6% (95% CI 33.1-69.9), specificity 46.7% (28.3-65.7), positive likelihood ratio 1.03 (95% CI 0.62-1.72), and negative likelihood ratio 1.10 (95% CI 0.63-1.93). The CCTA: DSE ratio of true-positive and false-positive rates was 1.70 (95% CI 1.65-1.75) and 1.00 (95% CI 0.91-1.09), respectively, when non-contributive CCTA and DSE were both considered positive. Only one missed acute coronary syndrome was observed at six months.


CONCLUSIONS
CCTA has higher diagnostic performance than DSE in the evaluation of patients with recent chest pain, normal ECG findings, and negative troponine to exclude coronary artery disease.
University Paris Descartes, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Department of Cardiology, Paris, France; University Hospital of Rouen, Hospital Charles Nicolle, Department of Cardiology, INSERM UMR 1096, Rouen, France.
Eric
E
Durand
University Hospital of Rouen, Hospital Charles Nicolle, Department of Cardiology, INSERM UMR 1096, Rouen, France.
Fabrice
F
Bauer
University of Versailles-Saint Quentin, Assistance Publique-Hôpitaux de Paris, Ambroise Paré Hospital, Department of Cardiology, Boulogne, France.
Nicolas
N
Mansencal
University Paris Descartes, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Department of Radiology, and INSERM 970 PARCC, Paris, France.
Arshid
A
Azarine
University Paris Descartes, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Department of Cardiology, Paris, France.
Benoit
B
Diebold
University Paris Descartes, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Department of Cardiology, Paris, France.
Albert
A
Hagege
University Paris Descartes, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Department of Cardiology, Paris, France.
Ludivine
L
Perdrix
University of Bretagne Occidentale, Department of Cardiology, CHU de la Cavale Blanche, EA 4524 Brest, France.
Martine
M
Gilard
University of Bretagne Occidentale, Department of Cardiology, CHU de la Cavale Blanche, EA 4524 Brest, France.
Yannick
Y
Jobic
University Hospital of Rouen, Hospital Charles Nicolle, Department of Cardiology, INSERM UMR 1096, Rouen, France.
Hélène
H
Eltchaninoff
University Paris Descartes, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Department of Radiology, and INSERM 970 PARCC, Paris, France.
Mourad
M
Bensalah
University Hospital of Rouen, Hospital Charles Nicolle, Department of Radiology, INSERM UMR 1096, Rouen, France.
Benjamin
B
Dubourg
University Hospital of Rouen, Hospital Charles Nicolle, Department of Radiology, INSERM UMR 1096, Rouen, France.
Jérôme
J
Caudron
University Paris Descartes, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Department of Epidemiology and Clinical Research, Paris, France.
Ralph
R
Niarra
University Paris Descartes, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Department of Epidemiology and Clinical Research, Paris, France.
Gilles
G
Chatellier
University Hospital of Rouen, Hospital Charles Nicolle, Department of Radiology, INSERM UMR 1096, Rouen, France.
Jean-Nicolas
JN
Dacher
University Paris Descartes, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Department of Radiology, and INSERM 970 PARCC, Paris, France. Electronic address: elie.mousseaux@aphp.fr.
Elie
E
Mousseaux
D000368:Aged; D002637:Chest Pain / Q000097:blood* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000072226:Computed Tomography Angiography / Q000592:standards*; D004280:Dobutamine / Q000008:administration & dosage*; D025401:Echocardiography, Stress / Q000592:standards*; D004562:Electrocardiography / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D014336:Troponin / Q000097:blood*
D014336:Troponin; D004280:Dobutamine
CCTA; Chest pain; Dobutamine-stress echocardiography