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Original article
CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease
  1. Erica Maffei1,
  2. Sara Seitun1,
  3. Chiara Martini1,
  4. Alessandro Palumbo1,2,
  5. Giuseppe Tarantini3,
  6. Elena Berti4,
  7. Roberto Grilli4,
  8. Carlo Tedeschi5,
  9. Giancarlo Messalli6,
  10. Andrea Guaricci7,
  11. Annick C Weustink2,
  12. Nico RA Mollet2,
  13. Filippo Cademartiri1,2
  1. 1Department of Radiology and Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy
  2. 2Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
  3. 3Department of Cardiology, Academic Hospital, Padua, Italy
  4. 4Agency for Health and Social Care of Emilia-Romagna, Bologna, Italy
  5. 5Department of Cardiology, San Gennaro Hospital, Napoli, Italy
  6. 6Radiology, SDN Foundation, Naples, Italy
  7. 7Department of Cardiology, Academic Hospital, Foggia, Italy
  1. Correspondence to Dr Filippo Cademartiri, Department of Radiology, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci, 14 43100, Parma, Italy; filippocademartiri{at}hotmail.com

Abstract

Objective To evaluate diagnostic accuracy of exercise ECG (ex-ECG) versus 64-slice CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis in a population with low-to-intermediate pre-test likelihood of coronary artery disease (CAD).

Design Retrospective single centre.

Setting Tertiary academic hospital.

Patients 177 consecutive patients (88 men, 89 women, mean age 53.5±7.6 years) with chest pain and low-to-intermediate pre-test likelihood of CAD were retrospectively enrolled.

Interventions All patients underwent ex-ECG, CT-CA and invasive coronary angiography (ICA).

Main outcome measure A lumen diameter reduction of ≥50% was considered as significant stenosis for CT-CA. Ex-ECG was classified as positive, negative or non-diagnostic. Results were compared with ICA. Diagnostic accuracy of CT-CA and ex-ECG was calculated using ICA as the reference standard. A parallel comparative analysis using a cut-off value of 70% for significant lumen reduction was also performed too.

Results ICA disclosed an absence of significant stenosis (≥50% luminal narrowing) in 85.3% (151/177) patients, single-vessel disease in 9.0% (16/177) patients and multivessel disease in 5.6% (10/177) patients. Prevalence of obstructive disease at ICA was 14.7% (26/177). Sensitivity, specificity, positive and negative predictive values at the patient level were 100.0%, 98.7%, 92.9%, 100%, respectively, for CT-CA and 46.2%, 16.6%, 8.7%, 64.1%, respectively, for ex-ECG. Agreement between CT-CA and ex-ECG was 20.9%. CT-CA performed equally well in men and women, while ex-ECG had a better performance in men. After considering the cut-off value of 70% for significant stenosis, the difference between CT-CA and ex-ECG remained significant (p<0.01), with a low agreement (21.5%).

Conclusions CT-CA provides optimal diagnostic performance in patients with atypical chest pain and low-to-intermediate risk of CAD. Ex-ECG has poor diagnostic accuracy in this population. Concerns are related to risk of radiation dose versus the benefits of correct disease stratification.

  • CT coronary angiography
  • invasive coronary angiography
  • clinical value
  • exercise ECG
  • low–intermediate pre-test likelihood
  • atypical chest pain
  • CT scanning, exercise testing, coronary artery disease (CAD)

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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