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

Radiol Med. 2009 Jun;114(4):513-23. doi: 10.1007/s11547-009-0388-4. Epub 2009 Apr 13.
[Article in English, Italian]

Abstract

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>or=70 beats/minute. In order to identify or exclude patients with significant stenoses (>or=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-infinity) 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.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Algorithms
  • Angina Pectoris / diagnosis*
  • Angina Pectoris / physiopathology
  • Coronary Angiography*
  • Electrocardiography / methods*
  • Exercise Test / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Tomography, X-Ray Computed*