Computed tomography coronary angiography vs. stress ECG in patients with stable angina
F Cademartiri1, L La Grutta, A Palumbo
1Dipartimento di Radiologia e Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. filippocademartiri@hotmail.com
Insights
Multislice computed tomography coronary angiography (MSCT-CA) effectively diagnoses coronary artery disease (CAD) in stable angina patients. This noninvasive tool accurately detects or excludes significant blockages, aiding diagnostic workup.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Chronic chest pain is a common symptom requiring accurate diagnosis of coronary artery disease (CAD).
- Stress electrocardiography (ECG) is a standard diagnostic tool, but its accuracy can be limited.
- Multislice computed tomography coronary angiography (MSCT-CA) offers a noninvasive imaging alternative.
Purpose of the Study:
- To compare the diagnostic utility of MSCT-CA versus stress ECG in patients with chronic chest pain.
- To evaluate the role of MSCT-CA in identifying significant coronary stenoses.
- To assess the impact of MSCT-CA on the post-test probability of CAD.
Main Methods:
- 43 patients with stable angina underwent MSCT-CA after routine workup including stress ECG and conventional coronary angiography (CA).
- Inclusion criteria: sinus rhythm and ability to hold breath for 12 seconds.
- Likelihood ratios were calculated for stress ECG and MSCT-CA to determine post-test probabilities of significant CAD.
Main Results:
- The pre-test probability for significant CAD was 74%.
- MSCT-CA demonstrated higher diagnostic accuracy with likelihood ratios of 10.0 (positive) and 0.0 (negative) compared to stress ECG.
- MSCT-CA significantly altered post-test probabilities, increasing the likelihood of significant CAD after a positive stress test to 100% and after a negative test to 86%.
Conclusions:
- Noninvasive MSCT-CA is a valuable tool for diagnosing stable angina.
- MSCT-CA accurately detects or excludes significant coronary artery disease.
- The findings support the integration of MSCT-CA into the diagnostic pathway for patients with suspected CAD.
Purpose:
This study compared the role of multislice computed tomography coronary angiography (MSCT-CA) and stress electrocardiography (ECG) in the diagnostic workup of patients with chronic chest pain.
Materials And Methods:
MSCT-CA was performed in 43 patients (31 men, 12 women, mean age 58.8+/-7.7 years) with stable angina after a routine diagnostic workup involving stress ECG and conventional CA. The following inclusion criteria were adopted: sinus rhythm and ability to hold breath for 12 s. Beta-blockers were administered in patients with heart rate>or=70 beats/minute. In order to identify or exclude patients with significant stenoses (>or=50% lumen), we determined posttest likelihood ratios of stress test and MSCT-CA separately and of MSCT-CA performed after the stress test.
Results:
The pretest probability of significant coronary artery disease (CAD) was 74%. Positive and negative likelihood ratios were 2.3 [95% confidence interval (CI) 1.0-5.3] and 0.3 (95% CI: 0.2-0.7) for the stress test and 10.0 (95% CI: 1.8-78.4) and 0.0 (95% CI: 0.0-infinity) for MSCT-CA, respectively. MSCT-CA increased the posttest probability of significant CAD after a negative stress test from 50% to 86% and after a positive stress test from 88% to 100%. MSCT-CA correctly detected all patients without CAD.
Conclusions:
Noninvasive MSCT-CA is a potentially useful tool in the diagnostic workup of patients with stable angina owing to its capability to detect or exclude significant CAD.
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