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J Am Coll Cardiol. 2007 Oct 9;50(15):1469-75. Epub 2007 Sep 24.

64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease.

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1
Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands.

Abstract

OBJECTIVES:

We assessed the usefulness of 64-slice computed tomography coronary angiography (CTCA) to detect or rule out coronary artery disease (CAD) in patients with various estimated pretest probabilities of CAD.

BACKGROUND:

The pretest probability of the presence of CAD may impact the diagnostic performance of CTCA.

METHODS:

Sixty-four-slice CTCA (Sensation 64, Siemens, Forchheim, Germany) was performed in 254 symptomatic patients. Patients with heart rates > or =65 beats/min received beta-blockers before CTCA. The pretest probability for significant CAD was estimated by type of chest discomfort, age, gender, and traditional risk factors and defined as high (> or =71%), intermediate (31% to 70%), and low (< or =30%). Significant CAD was defined as the presence of at least 1 > or =50% coronary stenosis on quantitative coronary angiography, which was the standard of reference. No coronary segments were excluded from analysis.

RESULTS:

The estimated pretest probability of CAD in the high (n = 105), intermediate (n = 83), and low (n = 66) groups was 87%, 53%, and 13%, respectively. The diagnostic performance of the computed tomography (CT) scan was different in the 3 subgroups. The estimated post-test probability of the presence of significant CAD after a negative CT scan was 17%, 0%, and 0% and after a positive CT scan was 96%, 88%, and 68%, respectively.

CONCLUSIONS:

Computed tomography coronary angiography is useful in symptomatic patients with a low or intermediate estimated pretest probability of having significant CAD, and a negative CT scan reliably rules out the presence of significant CAD. Computed tomography coronary angiography does not provide additional relevant diagnostic information in symptomatic patients with a high estimated pretest probability of CAD.

PMID:
17919567
DOI:
10.1016/j.jacc.2007.07.007
[Indexed for MEDLINE]
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