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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
04:40

Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans

Published on: August 28, 2018

Normal coronary arteriogram. An avoidable test?

C Ilsley, A Stockley, D Clitsakis

    British Heart Journal
    |December 1, 1982
    PubMed

    Insights

    For patients with atypical chest pain, combining exercise electrocardiography and thallium-201 scintigraphy effectively identifies those with normal coronary arteries. This approach can help avoid unnecessary coronary arteriography in this subgroup, improving diagnostic efficiency.

    Area of Science:

    • Cardiology
    • Diagnostic Imaging

    Background:

    • Coronary arteriography reveals normal vessels in 10-20% of patients with chest pain, often linked to "atypical" angina.
    • Standard non-invasive tests show lower accuracy in patients with atypical angina compared to those with typical angina.

    Purpose of the Study:

    • To prospectively evaluate combined 12-lead exercise electrocardiography and thallium-201 scintigraphy.
    • To determine if normal coronary arteriograms are avoidable in patients with atypical angina presenting with chest pain.

    Main Methods:

    • Sixty-seven consecutive patients with atypical angina underwent maximal exercise testing and thallium scintigraphy prior to coronary arteriography.
    • Assessed predictive accuracy of individual and combined tests for identifying coronary artery disease.

    Main Results:

    • Chest pain during exercise was a poor predictor of coronary disease in this cohort.
    • Sensitivity for detecting coronary disease was 45% for exercise testing and 73% for thallium scintigraphy.
    • Combined testing achieved 96% predictive accuracy for normal coronary arteries and 82% for coronary disease.

    Conclusions:

    • Combined exercise electrocardiography and thallium scintigraphy demonstrate high predictive accuracy for normal coronary arteries in patients with atypical angina.
    • Withholding coronary arteriography in patients with negative results from both tests could significantly reduce unnecessary procedures.
    • This strategy offers a potential method to decrease the rate of normal coronary arteriograms with minimal risk of missing significant coronary disease.

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