Clinical Evaluation and Calcium Score as Methods for Selecting Patients Eligible for CT Angiogram (original) (raw)
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2014
PURPOSE: Our aim was to compare the prognostic performance of computed tomography coronary angiography (CTA) and exercise electrocardiography (ex-ECG) in patients with suspected coronary artery disease (CAD). METHODS: We enrolled 60 patients (age 61.3 ± 10.4 years, 40 men) with angina and no history of CAD. All underwent ex-ECG and CTA and were followed for 12 months. The endpoints were cardiac events - nonfatal myocardial infarction, cardiac death, and revascularization. RESULTS: ex-ECG and CTA were positive in 36 (60%) and 24 (40%) of 60 patients, respectively. Both ex-ECG and CTA were predictors of cardiac events (hazard ratio [HR]: 2, p < 0.0001 and HR: 20, 95% p < 0.0001, respectively) and hard cardiac events (HR: 1.9, 95% ,p = 0.02 and HR: 6.8; p < 0.0001, respectively), in a multivariate analysis, CAD with ≥50% stenoses detected by CTA was the only independent predictor of hard cardiac events. Ex-ECG provides a further risk stratification in the subset of patients wi...
Prognostic value of coronary CT angiography and exercise ECG
European Heart Journal, 2013
Cardiovascular computed tomography imaging 839 rograde approach alone and 13 (38.2%) of the attempts utilized a bidirectional approach. The overall success rate per attempt was 85.3%. Calcium occupying >50% of CSA by CTCA was the only predictor of failure of the antegrade approach for CTO PCI; p=0.036. There were trends of longer estimated CTO duration and longer estimated CTO length in the failed antegrade approaches for CTO PCI (p=0.073, p=0.063 respectively). None of the CTCA or the CCA factors was found to predict the outcome of the retrograde approach for CTO PCI. A trend of successful outcome of the retrograde approach for CTO PCI was noted with higher Werner collateral channel grades (p=0.057). Conclusions: CTCA provides better means of detection and assessment of calcification within the coronary CTO lesions than CCA. Severe calcification (>50% of CSA by CTCA) was the only statistically significant predictor of failure of the antegrade approach for CTO PCI.
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2013
The purpose of this study was to assess the change in theoretical probability of coronary artery disease (CAD) in patients with suspected CAD undergoing coronary CT angiography (CCTA) as first line test vs. patients who underwent CCTA after an exercise ECG. Pre- and post-test probabilities of CAD were assessed in 158 patients with suspected CAD undergoing dual-source CCTA as the first-line test (Group A) and in 134 in whom CCTA was performed after an exercise ECG (Group B). Pre-test probabilities were calculated based on age, gender and type of chest pain. Post-test probabilities were calculated according to Bayes' theorem. There were no significant differences between the groups regarding pre-test probability (median 23.5% [13.3-37.8] in group A vs. 20.5% [13.4-34.5] in group B; p=0,479). In group A, the percentage of patients with intermediate likelihood of disease (10-90%) was 90% before testing and 15% after CCTA (p<0,001), while in group B, it was 95% before testing, 87%...
International Journal of Cardiology, 2013
Background: Although conventional (CAG) and computed tomography angiography (CTA) are reliable diagnostic modalities for exclusion of obstructive coronary artery disease (CAD), they are costly and with considerable exposure to radiation and contrast media. We compared the accuracy of coronary calcium scanning (CCS) and exercise electrocardiography (X-ECG) as less expensive and non-invasive means to rule out obstructive CAD. Methods: In a rapid-access chest pain clinic, 791 consecutive patients with stable chest pain were planned to undergo X-ECG and dual-source CTA with CCS. According to the Duke pre-test probability of CAD patients were classified as low (b 30%), intermediate (30-70%) or high risk (N 70%). Angiographic obstructive CAD (N 50% stenosis by CAG or CTA) was found in 210/791 (27%) patients, CAG overruling any CTA results. Results: Obstructive CAD was found in 12/281 (4%) patients with no coronary calcium and in 73/319 (23%) with a normal X-ECG (p b 0.001). No coronary calcium was associated with a substantially lower likelihood ratio compared to X-ECG; 0.11, 0.13 and 0.13 vs. 0.93, 0.55 and 0.46 in the low, intermediate and high risk group. In low risk patients a negative calcium score reduced the likelihood of obstructive CAD to less than 5%, removing the need for further diagnostic work-up. CCS could be performed in 754/756 (100%) patients, while X-ECG was diagnostic in 448/756 (59%) patients (p b 0.001). Conclusions: In real-world patients with stable chest pain CCS is a reliable initial test to rule out obstructive CAD and can be performed in virtually all patients.