| Stratification for noninvasive coronary angiography: patient preselection considering atypical angina pectoris, conventional cardiovascular risk assessment, and calcium scoring. | |
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MedLine Citation:
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PMID: 19305353 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Noninvasive coronary angiography (NCA) is recommended to be applied as a filter before invasive coronary angiography in patients with intermediate cardiovascular risk. DESIGN: In this prospective single-center study, we validated multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)-based NCA by primarily selecting patients with atypical angina pectoris (AAP). METHODS: In 68 patients (63.6+/-11.4 years) with AAP, the Prospective Cardiovascular Muenster Study score and the Agatston score equivalent (ASE; calcium score) were initially determined for cardiovascular risk assessment. Subsequently, MSCT and MRI-based NCA were performed followed by quantitative invasive coronary angiography for validation. All tests were finally analyzed. RESULTS: CAD (prevalence 38.2%) was diagnosed in 67.7% of patients at high, 61.5% at intermediate, and 37.8% at low cardiovascular risk according to the Prospective Cardiovascular Muenster Study. CAD was diagnosed in 88.2% of patients with an ASE >or=75th percentile and in 90.9% with an ASE >or=90th percentile. With regard to NCA, patient-based analysis resulted in a sensitivity of 96.2% for MSCT versus 69.2% for MRI, in a specificity of 95.2 versus 64.3%, in a positive predictive value of 97.6 versus 77.1%, in a negative predictive value of 92.6 versus 54.5%, and a diagnostic accuracy of 95.6 versus 66.2% (P<0.05). CONCLUSION: In a patient group with a heterogeneous cardiovascular risk, primarily considering AAP allows for effective patient preselection for NCA. This may be optimized by precluding patients with an ASE >or=75th percentile. MSCT rather than MRI may then effectively be involved. |
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Authors:
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Christoph Langer; Marcus Wiemer; Andreas Peterschröder; Krista Franzke; Klaus-Peter Mellwig; Frank van Buuren; Wilhelm Koester-Eiserfunke; Thomas Butz; Juergen Diekmann; Dieter Horstkotte |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Validation Studies |
Journal Detail:
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Title: European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology Volume: 16 ISSN: 1741-8275 ISO Abbreviation: Eur J Cardiovasc Prev Rehabil Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-04-16 Completed Date: 2009-06-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101192000 Medline TA: Eur J Cardiovasc Prev Rehabil Country: England |
Other Details:
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Languages: eng Pagination: 201-9 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Germany. clanger@hdz-nrw.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angina Pectoris / etiology*, pathology Calcinosis / complications, diagnosis* Cardiovascular Diseases / etiology*, pathology Coronary Angiography / methods* Coronary Artery Disease / complications, diagnosis* Female Humans Magnetic Resonance Angiography* Male Middle Aged Patient Selection* Predictive Value of Tests Prospective Studies Reproducibility of Results Risk Assessment Risk Factors Tomography, Emission-Computed, Single-Photon Tomography, X-Ray Computed* |
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