Document Detail


Computed tomography versus exercise electrocardiography in patients with stable chest complaints: real-world experiences from a fast-track chest pain clinic.
MedLine Citation:
PMID:  19622516     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare the diagnostic performance of CT angiography (CTA) and exercise electrocardiography (XECG) in a symptomatic population with a low-intermediate prevalence of coronary artery disease (CAD). DESIGN: Prospective registry. SETTING: Tertiary university hospital. PATIENTS: 471 consecutive ambulatory patients with stable chest pain complaints, mean (SD) age 56 (10), female 227 (48%), pre-test probability for significant CAD >5%. INTERVENTION: All patients were intended to undergo both 64-slice, dual-source CTA and an XECG. Clinically driven quantitative catheter angiography was performed in 98 patients. MAIN OUTCOME MEASURES: Feasibility and interpretability of, and association between, CTA and XECG, and their diagnostic performance with invasive coronary angiography as reference. RESULTS: CTA and XECG could not be performed in 16 (3.4%) vs 48 (10.2%, p<0.001), and produced non-diagnostic results in 3 (0.7%) vs 140 (33%, p<0.001). CTA showed > or =1 coronary stenosis (> or =50%) in 140 patients (30%), XECG was abnormal in 93 patients (33%). Results by CTA and XECG matched for 185 patients (68%, p = 0.63). Catheter angiography showed obstructive CAD in 57/98 patients (58%). Sensitivity, specificity, positive and negative predictive value of CTA to identify patients with > or =50% stenosis was 96%, 37%, 67% and 88%, respectively; compared with XECG: 71%, 76%, 80% and 66%, respectively. Quantitative CTA slightly overestimated diameter stenosis: 6 (21)% (R = 0.71), compared with QCA. Of the 312 patients (66%) with a negative CTA, 44 (14%) had a positive XECG, but only 2/17 who underwent catheter angiography had significant CAD. CONCLUSION: CTA is feasible and diagnostic in more patients than XECG. For interpretable studies, CTA has a higher sensitivity, but lower specificity for detection of CAD.
Authors:
K Nieman; T Galema; A Weustink; L Neefjes; A Moelker; P Musters; R de Visser; N Mollet; H Boersma; P J de Feijter
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-07-20
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  95     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-09-29     Completed Date:  2009-10-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  1669-75     Citation Subset:  AIM; IM    
Affiliation:
Erasmus Medical Centre, Thoraxcenter Bd 434, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. Koennieman@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Chest Pain / etiology*
Coronary Angiography / methods*
Coronary Artery Disease / complications,  radiography*
Electrocardiography / methods
Exercise Test / methods
Feasibility Studies
Female
Humans
Male
Middle Aged
Pain Clinics
Prospective Studies
Risk Assessment
Tomography, X-Ray Computed / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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