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Midterm prognosis of patients with suspected coronary artery disease and normal multislice computed tomographic

Martine Gilard1, Grégoire Le Gal, Jean-Christophe Cornily

  • 1Department of Cardiology, Brest University Hospital, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France. Martine.gilard@chu-brest.fr

Archives of Internal Medicine
|August 19, 2007
PubMed

Insights

Multislice computed tomographic coronary angiography (MSCT-CAG) safely rules out coronary artery disease (CAD). A normal MSCT-CAG result allows for less invasive patient management, reducing the need for conventional coronary angiography (C-CAG).

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Techniques

Background:

  • Conventional coronary angiography (C-CAG) is the gold standard for diagnosing coronary artery disease (CAD).
  • Multislice computed tomographic coronary angiography (MSCT-CAG) shows high sensitivity and negative predictive value for CAD diagnosis compared to C-CAG.
  • The study aims to evaluate the safety of excluding CAD based solely on a normal MSCT-CAG.

Purpose of the Study:

  • To prospectively assess the safety of ruling out coronary artery disease (CAD) using only a normal multislice computed tomographic coronary angiography (MSCT-CAG) result.
  • To determine if MSCT-CAG can be a reliable standalone test for excluding CAD.
  • To evaluate the clinical outcomes of patients managed non-invasively after a normal MSCT-CAG.

Main Methods:

  • 141 patients with initially normal MSCT-CAG results (excluding those with high calcification or non-interpretable scans) were included.
  • Conventional coronary angiography (C-CAG) was not performed in patients with normal MSCT-CAG results.
  • Patients were followed for clinical endpoints including mortality, subsequent C-CAG, and myocardial infarction.

Main Results:

  • In 141 patients with normal MSCT-CAG, follow-up (mean 14.7 months) showed 0% mortality, 3.5% subsequent C-CAG, and 0.7% myocardial infarction.
  • These event rates favorably compare to historical data following normal C-CAG (0.4% death, 4.3% C-CAG, 0.6% MI).
  • MSCT-CAG demonstrated a low rate of adverse events in patients with normal scans.

Conclusions:

  • Multislice computed tomographic coronary angiography (MSCT-CAG) safely excludes coronary artery disease (CAD) in patients with suspected disease.
  • A normal MSCT-CAG allows for less invasive patient management.
  • This approach reduces the number of patients requiring conventional coronary angiography (C-CAG).
Abstract

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