64-multislice computed tomography in consecutive patients with suspected or proven coronary artery disease: initial...

The improved accuracy of 64-multislice CT (MSCT) suggests that this technique may replace other non-invasive methods to detect clinically significant coronary atherosclerosis. The aim of the present study was to assess the clinical usefulness of in consecutive patients with suspected or proven coronary artery disease (CAD).

64-MSCT was performed in 56 patients (age 56+/-16 years, 50 male) with suspected or proven CAD (35 patients with chest pain/positive provocative tests/risk factors), 18 with documented significant CAD, CABG surgery or stent implantation, 3 non-assessable with selective angiography because of peripheral vascular disease or large aneurysms of the ascending aorta.

One patient was excluded because of contrast extravasation. In 30/55 patients (54%) 64-MSCT excluded significant coronary stenoses; in 13/55 patients (24%) angiography and/or angioplasty were recommended to treat (3) 50% diameter stenoses shown by MSCT, a diagnosis confirmed in 9 (81.8%) of the 11 patients who underwent further investigations; 12/55 patients (22%) needed angiography or other preliminary non-invasive tests because 64-MSCT was of insufficient diagnostic quality. Predictors of a poor diagnostic quality of 64-MSCT were older age (64+/-8 vs. 55+/-11 years, p<0.007), diabetes mellitus (42% vs. 9%, p=0.017), previous angiography, angioplasty or CABG surgery (83% vs. 26%, p<0.0001), Agatston score>400 (75% vs. 21%, p<0.002).

64-MSCT provided complete diagnostic coronary images sufficient for clinical decision making in the vast majority (78%) of a consecutive group of patients studied for suspected or proven CAD. Predictors of diagnostic failure were massive calcification, long-standing known coronary atherosclerosis or previous CABG/stent implantation, old age and diabetes mellitus.