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J Am Coll Cardiol, 2000; 36:32-38 © 2000 by the American College of Cardiology Foundation |
* Saint John’s Cardiovascular Research Center, Division of Cardiology, Harbor–UCLA Research and Education Institute, Torrance, California, USA
Division of Cardiology, University of California, Irvine, Long Beach Veterans Hospital, Long Beach, California, USA
Department of Statistics, University of California, Riverside, California, USA
Manuscript received January 20, 1999; revised manuscript received January 18, 2000, accepted March 6, 2000.
Reprint requests and correspondence: Dr. David M. Shavelle, Division of Cardiology, Box 356422, University of Washington School of Medicine, Seattle, Washington 98195
dshav{at}u.washington.edu
OBJECTIVES
This study compared coronary artery calcium (CC) as detected by electron beam computed tomography (EBCT) with conventional stress testing in the evaluation of patients with symptoms suggestive of coronary artery disease (CAD).
BACKGROUND
Exercise electrocardiogram treadmill stress testing (treadmill-ECG) is limited by its requirement of a normal resting ECG and the ability of the patient to exercise adequately. The addition of myocardial imaging agents such as technetium improves the sensitivity and specificity but substantially increases the cost and prolongs the testing time. The use of EBCT provides a noninvasive and rapid method for identifying the presence and amount of CC, which has been shown to be related to atherosclerosis, and may provide additional information in combination with more traditional noninvasive testing methods.
METHODS
A total of 97 patients underwent technetium stress testing (technetium-stress), treadmill-ECG, and EBCT coronary scanning within three months of coronary angiography for the evaluation of chest pain.
RESULTS
The relative risk (RR) of obstructive angiographic CAD for an abnormal test was higher for EBCT (4.53) than either treadmill-ECG (1.72) or technetium-stress (1.96). The low specificity of EBCT (47%) was improved by the addition of treadmill-ECG (83%, p < 0.05).
CONCLUSIONS
Electron beam computed tomography has a higher diagnostic ability than either treadmill-ECG or technetium-stress for the detection of obstructive angiographic CAD. Electron beam computed tomography is an accurate and noninvasive alternative to traditional stress testing for the detection of obstructive CAD in symptomatic patients.
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