| Prevalence of obstructive coronary artery disease in an outpatient cardiac CT angiography environment. | |
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MedLine Citation:
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PMID: 17651836 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To determine the prevalence of significant obstructive disease and non-diagnostic studies using coronary computed tomographic angiography (CTA) in an outpatient environment, to establish if CTA could help avoid unnecessary diagnostic cardiac catheterizations. METHODS: We evaluated all cases consecutively performed in our outpatient CTA laboratory seen over one year with an indication that could warrant a cardiac catheterization to establish the presence or absence of coronary artery disease (CAD). Excluded were patients without established indications for cardiac catheterization and those with known CAD (i.e.- prior myocardial infarction, revascularization). Four hundred and ninety-three (493) CTA case studies were included for the analysis. Patients were classified as normal (no luminal irregularities seen), non-obstructive coronary disease (<50% stenosis), significant obstructive coronary disease (>50% stenosis), or a non-diagnostic study. We assumed that all patients assigned to the obstructive CAD group and the non-diagnostic study group would require a cardiac catheterization. In the remaining two groups, a cardiac catheterization would not be necessary for diagnosis or treatment. RESULTS: Of the 493 index cases evaluated, 157 (32%) cases were reported to be normal, 204 patients were classified as having non-obstructive disease (41%), 93 patients were defined to have obstructive CAD (19%), and 39 cases were inconclusive (8%). Thus, in 27% of the study population, a conventional coronary angiography would be indicated to clarify the diagnosis or provide definitive disease severity for subsequent revascularization. CONCLUSION: Among ambulatory patients referred for CT angiography with symptoms or positive (or equivocal) cardiac stress tests, 73% of patients were found to have either normal coronary arteries or non-obstructive disease. Given the high negative predictive power of cardiac CTA (93-99%), these patients most likely would not require subsequent invasive coronary angiography. A strategy of selective cardiac catheterization may substantially decrease unnecessary diagnostic cardiac catheterizations and reduce health care expenses. |
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Authors:
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Matthew J Budoff; Ambarish Gopal; Khawar M Gul; Song S Mao; Hans Fischer; Ronald J Oudiz |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2007-07-24 |
Journal Detail:
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Title: International journal of cardiology Volume: 129 ISSN: 1874-1754 ISO Abbreviation: Int. J. Cardiol. Publication Date: 2008 Sep |
Date Detail:
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Created Date: 2008-08-19 Completed Date: 2009-02-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8200291 Medline TA: Int J Cardiol Country: Netherlands |
Other Details:
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Languages: eng Pagination: 32-6 Citation Subset: IM |
Affiliation:
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Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA. Budoff@ucla.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Ambulatory Care / methods* Coronary Angiography / methods* Coronary Artery Disease / epidemiology*, radiography* Female Heart Catheterization Humans Male Middle Aged Prevalence Tomography, X-Ray Computed / methods* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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