64-Slice Computed Tomography Coronary Angiography in Patients With High, Intermediate, or Low Pretest Probability of Significant Coronary Artery Disease W. Bob Meijboom, Carlos A. G. van Mieghem, ...Nico R. Mollet, Francesca Pugliese, Annick C. Weustink, Niels van Pelt, Filippo Cademartiri, Koen Nieman, Eric Boersma, Peter de Jaegere, Gabriel P. Krestin, Pim J. de Feyter We assessed the usefulness of 64-slice computed tomography (CT) coronary angiography to detect or rule out coronary artery disease (CAD) in patients with various estimated pretest probabilities. The estimated pretest probability of CAD in patients with high, intermediate, or low pretest probability was 87%, 53%, and 13%. The estimated post-test probability of a negative CT scan was 17%, 0%, and 0%, and of a positive CT scan was 96%, 88%, and 68%. Computed tomography coronary angiography is useful in symptomatic patients with low or intermediate estimated pretest probability of having CAD and does not provide additional diagnostic information in patients with a high estimated pretest probability.
We compared the diagnostic accuracy of 64-slice computed tomographic (CT) coronary angiography to detect significant coronary artery disease (CAD) in women and men. The 64-slice CT coronary ...angiography was performed in 402 symptomatic patients, 123 women and 279 men, with CAD prevalence of 51% and 68%, respectively. Significant CAD, defined as ≥50% coronary stenosis on quantitative coronary angiography, was evaluated on a patient, vessel, and segment level. The sensitivity and negative predictive value to detect significant CAD was very good, both for women and men (100% vs 99%, p = NS; 100% vs 98%, p = NS), whereas diagnostic accuracy (88% vs 96%; p <0.01), specificity (75% vs 90%, p <0.05), and positive predictive value (81% vs 95%, p <0.001) were lower in women. The per-segment analysis demonstrated lower sensitivity in women compared with men (82% vs 93%, p <0.001). The sensitivity in women did not show a difference in proximal and midsegments, but was significantly lower in distal segments (56% vs 85%, p <0.05) and side branches (54% vs 89%, p <0.001). In conclusion, CT coronary angiography reliably rules out the presence of obstructive CAD in both men and women. Specificity and positive predictive value of CT coronary angiography were lower in women. The sensitivity to detect stenosis in small coronary branches was lower in women compared with men.
Reply Meijboom, W. Bob, MD; Meijs, Matthijs F.L., MD; Schuijf, Joanne D., MD, PhD ...
Journal of the American College of Cardiology,
2009, Letnik:
53, Številka:
19
Journal Article
PDF
