Document Detail


Usefulness of 64-slice multidetector computed tomography in diagnostic triage of patients with chest pain and negative or nondiagnostic exercise treadmill test result.
MedLine Citation:
PMID:  17398185     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The usefulness of 64-slice multidetector coronary computed tomography (MDCT) in a diagnostic triage of 100 consecutive patients (age 55.8+/-11.6 years; 57% men) with chest pain suspected to be ischemic in origin and a negative or nondiagnostic exercise treadmill test (ETT) result was examined. None of the patients had previously known coronary artery disease (CAD). MDCT showed obstructive (>or=50%) CAD in 29 patients; 13 of 59 patients (22%) with a negative and 16 of 41 patients (39%) with a nondiagnostic ETT result. High-risk (left main and/or 3-vessel) CAD was present in 3.3% of patients with a negative and 4.9% with a nondiagnostic ETT result. The 29 patients with obstructive CAD on MDCT had a higher mean Agatston calcium score (221+/-402 vs 40+/-77 U, p<0.001). Invasive coronary angiography confirmed MDCT findings in 26 of 29 patients (positive predictive value 90%) and 45 of 54 stenotic segments (83%) in a per-segment analysis. For the 71 patients without obstructive CAD on MDCT, clinically driven invasive angiography detected CAD in 1 of 15 patients (1 false-negative MDCT result) and 2 of another 5 patients who were referred for invasive angiography later during a 12-month follow-up period. In the remaining 51 patients, MDCT findings effectively allowed exclusion of obstructive CAD, and there were no major adverse clinical events during follow-up. In conclusion, in patients with chest pain possibly ischemic in origin, no previously known CAD, and a negative or nondiagnostic ETT result, contrast-enhanced 64-slice MDCT scanning was a useful tool to provide direct noninvasive coronary angiography and rapidly advance diagnostic triage.
Authors:
Ronen Rubinshtein; David A Halon; Tamar Gaspar; Jorge E Schliamser; Nisan Yaniv; Ronny Ammar; Moshe Y Flugelman; Nathan Peled; Basil S Lewis
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Publication Detail:
Type:  Journal Article     Date:  2007-02-15
Journal Detail:
Title:  The American journal of cardiology     Volume:  99     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-02     Completed Date:  2007-04-25     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  925-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angina Pectoris / etiology,  pathology,  radiography*
Calcinosis / radiography
Chest Pain / etiology,  pathology,  radiography*
Coronary Angiography
Coronary Artery Disease / complications,  pathology,  radiography
Coronary Stenosis / complications,  pathology,  radiography
Exercise Test*
False Negative Reactions
False Positive Reactions
Female
Follow-Up Studies
Humans
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Severity of Illness Index
Tomography, X-Ray Computed*
Triage*

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