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.
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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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