Computed tomography coronary angiography vs. stress ECG in patients with stable angina

Purpose This study compared the role of multislice computed tomography coronary angiography (MSCT-CA) and stress electrocardiography (ECG) in the diagnostic workup of patients with chronic chest pain. Materials and methods MSCT-CA was performed in 43 patients (31 men, 12 women, mean age 58.8±7.7 yea...
Ausführliche Beschreibung

Purpose This study compared the role of multislice computed tomography coronary angiography (MSCT-CA) and stress electrocardiography (ECG) in the diagnostic workup of patients with chronic chest pain. Materials and methods MSCT-CA was performed in 43 patients (31 men, 12 women, mean age 58.8±7.7 years) with stable angina after a routine diagnostic workup involving stress ECG and conventional CA. The following inclusion criteria were adopted: sinus rhythm and ability to hold breath for 12 s. Beta-blockers were administered in patients with heart rate ≥70 beats/minute. In order to identify or exclude patients with significant stenoses (≥50% lumen), we determined posttest likelihood ratios of stress test and MSCT-CA separately and of MSCT-CA performed after the stress test. Results The pretest probability of significant coronary artery disease (CAD) was 74%. Positive and negative likelihood ratios were 2.3 [95% confidence interval (CI) 1.0–5.3] and 0.3 (95% CI: 0.2–0.7) for the stress test and 10.0 (95% CI: 1.8–78.4) and 0.0 (95% CI: 0.0-∞) for MSCT-CA, respectively. MSCT-CA increased the posttest probability of significant CAD after a negative stress test from 50% to 86% and after a positive stress test from 88% to 100%. MSCT-CA correctly detected all patients without CAD. Conclusions Noninvasive MSCT-CA is a potentially useful tool in the diagnostic workup of patients with stable angina owing to its capability to detect or exclude significant CAD. Ausführliche Beschreibung