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CLINICAL RESEARCH: CARDIAC IMAGING

64-Slice Computed Tomography Coronary Angiography in Patients With High, Intermediate, or Low Pretest Probability of Significant Coronary Artery Disease

W. Bob Meijboom, MD^_*,, Carlos A.G. van Mieghem, MD^_*,, Nico R. Mollet, MD, PhD^_*,, Francesca Pugliese, MD^_*,, Annick C. Weustink, MD^_*,, Niels van Pelt, MD^_*,, Filippo Cademartiri, MD, PhD, Koen Nieman, MD, PhD^_*, Eric Boersma, MSc, PhD^_*, Peter de Jaegere, MD, PhD^_*, Gabriel P. Krestin, MD, PhD and Pim J. de Feyter, MD, PhD, FACC^_*,,_*

^_* Department of Cardiology, Thoraxcenter, Rotterdam, the Netherlands
Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.

Manuscript received March 14, 2007; revised manuscript received July 2, 2007, accepted July 10, 2007.

^_* Reprint requests and correspondence: Dr. Pim J. de Feyter, Erasmus Medical Center, Department of Cardiology and Radiology, Room Hs 207, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. (Email: p.j.defeyter{at}erasmusmc.nl).

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 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 (71%), intermediate (31% to 70%), and low (30%). Significant CAD was defined as the presence of at least 1 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.

Abbreviations and Acronyms   CAD = coronary artery disease   CCA = conventional coronary angiogram   CI = confidence interval   CT = computed tomography   CTCA = computed tomography coronary angiography   LR = likelihood ratio   QCA = quantitative coronary angiography

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