Abstract 8809: Strategy for Angina Pectoris Diagnosis based on Coronary Computed Tomography as Initial Test: a Prospective Pilot Study
Background: Coronary Computed Tomography (CCT) detects coronary obstruction with high sensibility and might be useful for angina pectoris diagnosis. We evaluated a strategy based on CCT as initial test.
Methods: One hundred and eighty patients with chest discomfort and suspected angina were prospectively referred to CCT with a 64-slice CT scan. Exclusion criteria were acute coronary syndrome, previous coronary artery disease and non sinus rhythm. Invasive angiogram was performed on the basis of CCT findings (stenosis >50%). Patients were classified into tertiles according to estimated pretest probability for obstructive CAD using the Duke Clinical Score (low, medium and high). Strategy failure was defined as 1/ performing invasive coronary angiogram (ICA) without subsequent revascularization or 2/ major adverse cardiac event (MACE) within 6 months in patients without significant stenosis by CCT.
Results: Pre test probability for CAD was 53% 29%. Significant stenosis was detected by CCT in 51 patients and 47 (26%) underwent ICA. Nineteen strategy failures were reported: 18 patients (10%) were referred to ICA but did not require revascularization and one MACE (one death) occurred in patients without significant stenosis by CCT.
*p<0.01 between risk tertiles
Conclusions: In conclusion, CCT as initial step for angina diagnosis is the most effective in patients with intermediate probability of CAD. In patients with low or high probability, it is associated with a high rate of unnecessary ICA but not with adverse event.
- © 2010 by American Heart Association, Inc.