PURPOSE: The authors sought to evaluate the incremental value of introducing coronary angiography with multidetector computed tomography (MDCT-CA) compared with the conventional diagnostic workup in managing patients with suspected coronary artery disease (CAD) workup. MATERIALS AND METHODS: A total of 531 consecutive patients underwent MDCT-CA between April 2008 and August 2010. For each patient the pretest probability of CAD was obtained by using the Morise score as well as the diagnostic performance of the exercise test and of MDCT-CA, considering conventional coronary angiography (CCA) as the gold standard. Based on these results, we calculated the posttest likelihood of CAD after stress testing, comparing the incremental diagnostic value for each category of cardiovascular risk with data obtained with MDCT-CA. The conventional diagnostic workup (without MDCT-CA) was then compared with the modified workup (including MDCT-CA). RESULTS: The diagnostic performance of the exercise test for identifying patients with significant lesions had a sensitivity and specificity of 20% and 88%, respectively, with positive (PPV) and negative (NPV) predictive value of 41% and 72%, respectively. Taking CA as the gold standard, MDCT-CA had 93% sensitivity, 89% specificity, 88% PPV and 93% NPV compared with CCA in evaluating significant stenoses in the per-patient analysis. The overall diagnostic accuracy of MDCT-CA was 91%. The exercise tests provided no significant incremental diagnostic value compared with cardiovascular history in patients with a low to intermediate risk. Comparison of the diagnostic accuracy of these protocols showed improved performance results for the modified protocol. CONCLUSIONS: MDCT-CA is the reference modality for the noninvasive exclusion of critical CAD. It provides a very high incremental diagnostic value compared with exercise testing in patients with a low to intermediate risk of CAD. The use of diagnostic protocols based on MDCT-CA ensures improved diagnostic performance compared with those involving conventional exercise electrocardiograms.
PURPOSE: The authors sought to evaluate the incremental value of introducing coronary angiography with multidetector computed tomography (MDCT-CA) compared with the conventional diagnostic workup in managing patients with suspected coronary artery disease (CAD) workup. MATERIALS AND METHODS: A total of 531 consecutive patients underwent MDCT-CA between April 2008 and August 2010. For each patient the pretest probability of CAD was obtained by using the Morise score as well as the diagnostic performance of the exercise test and of MDCT-CA, considering conventional coronary angiography (CCA) as the gold standard. Based on these results, we calculated the posttest likelihood of CAD after stress testing, comparing the incremental diagnostic value for each category of cardiovascular risk with data obtained with MDCT-CA. The conventional diagnostic workup (without MDCT-CA) was then compared with the modified workup (including MDCT-CA). RESULTS: The diagnostic performance of the exercise test for identifying patients with significant lesions had a sensitivity and specificity of 20% and 88%, respectively, with positive (PPV) and negative (NPV) predictive value of 41% and 72%, respectively. Taking CA as the gold standard, MDCT-CA had 93% sensitivity, 89% specificity, 88% PPV and 93% NPV compared with CCA in evaluating significant stenoses in the per-patient analysis. The overall diagnostic accuracy of MDCT-CA was 91%. The exercise tests provided no significant incremental diagnostic value compared with cardiovascular history in patients with a low to intermediate risk. Comparison of the diagnostic accuracy of these protocols showed improved performance results for the modified protocol. CONCLUSIONS: MDCT-CA is the reference modality for the noninvasive exclusion of critical CAD. It provides a very high incremental diagnostic value compared with exercise testing in patients with a low to intermediate risk of CAD. The use of diagnostic protocols based on MDCT-CA ensures improved diagnostic performance compared with those involving conventional exercise electrocardiograms.
Authors: S Achenbach; S Ulzheimer; U Baum; M Kachelriess; D Ropers; T Giesler; W Bautz; W G Daniel; W A Kalender; W Moshage Journal: Circulation Date: 2000-12-05 Impact factor: 29.690
Authors: Stephan Achenbach; Dieter Ropers; Axel Kuettner; Thomas Flohr; Bernd Ohnesorge; Herbert Bruder; Heike Theessen; Meri Karakaya; Werner G Daniel; Werner Bautz; Willi A Kalender; Katharina Anders Journal: Eur J Radiol Date: 2006-01-19 Impact factor: 3.528
Authors: Stephen Schroeder; Stephan Achenbach; Frank Bengel; Christof Burgstahler; Filippo Cademartiri; Pim de Feyter; Richard George; Philipp Kaufmann; Andreas F Kopp; Juhani Knuuti; Dieter Ropers; Joanne Schuijf; Laurens F Tops; Jeroen J Bax Journal: Eur Heart J Date: 2007-12-15 Impact factor: 29.983
Authors: Sebastian Leschka; Hans Scheffel; Lotus Desbiolles; Andre Plass; Oliver Gaemperli; Ines Valenta; Lars Husmann; Thomas G Flohr; Michele Genoni; Borut Marincek; Philipp A Kaufmann; Hatem Alkadhi Journal: Invest Radiol Date: 2007-08 Impact factor: 6.016
Authors: R Malagò; M D'Onofrio; I Baglio; S Brunelli; D Tavella; F Beltrame; P Benussi; R Pozzi Mucelli Journal: Radiol Med Date: 2009-08-07 Impact factor: 3.469
Authors: E Maffei; A Palumbo; C Martini; A Cuttone; F Ugo; E Emiliano; A Menozzi; L Vignali; V Brambilla; P Coruzzi; A Weustink; N Mollet; D Ardissino; C Reverberi; G Crisi; F Cademartiri Journal: Radiol Med Date: 2009-11-09 Impact factor: 3.469
Authors: Dieter Ropers; Ulrich Baum; Karsten Pohle; Katharina Anders; Stefan Ulzheimer; Bernd Ohnesorge; Christian Schlundt; Werner Bautz; Werner G Daniel; Stephan Achenbach Journal: Circulation Date: 2003-02-11 Impact factor: 29.690