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Computed tomography versus exercise electrocardiography in patients with stable chest compleints – real-world experiences from a fast-track chest pain clinic
  1. Koen Nieman (koennieman{at}hotmail.com)
  1. Erasmus MC, Netherlands
    1. Tjebbe Galema (t.galema{at}erasmusmc.nl)
    1. Erasmus MC, Netherlands
      1. Annick Weustink (a.weustink{at}erasmusmc.nl)
      1. Erasmus MC, Netherlands
        1. Lisan Neefjes (l.neefjes{at}erasmusmc.nl)
        1. Erasmus MC, Netherlands
          1. Adriaan Moelker (a.moelker{at}erasmusmc.nl)
          1. Erasmus MC, Netherlands
            1. Paul Musters (p.musterts{at}erasmusmc.nl)
            1. Erasmus MC, Netherlands
              1. Randall de Visser
              1. Erasmus MC, Netherlands
                1. Nico Mollet (n.mollet{at}erasmusmc.nl)
                1. Erasmus MC, Netherlands
                  1. Eric Boersma (h.boersma{at}erasmusmc.nl)
                  1. Erasmus MC, Netherlands
                    1. Pim J de Feyter (p.j.defeyter{at}erasmusmc.nl)
                    1. Erasmus MC, Netherlands

                      Abstract

                      Objective: To compare the diagnostic performance of CT angiography (CTA) and exercise electrocardiography (XECG) in a symptomatic population with a low-intermediate prevalence of coronary artery disease (CAD).

                      Design: Prospective registry.

                      Setting: Tertiary university hospital.

                      Patients: 471 consecutive ambulatory patients with stable chest pain complaints, age 56 (SD 10), female 227 (48%), pre-test probability for significant CAD >5%.

                      Intervention: All patients were intended to undergo both 64-slice dual-source CTA and XECG. Clinically driven quantitative invasive angiography (QCA) was performed in 98 patients.

                      Main outcome measures: Feasibility and interpretability of, and association between CTA and XECG, and their diagnostic performance with invasive coronary angiography as reference.

                      Results: CTA and XECG could not be performed in 16 (3.4%) vs. 48 (10%, P<0.001), and produced non-diagnostic results in 3 (0.7%) vs. 140 (33%, P<0.001). CTA showed significant obstruction in 140 patients (30%), XECG was abnormal in 93 (33%). CTA and XECG results matched for 185 patients (68%, P=0.63). Sensitivity, specificity, positive and negative predictive value of CTA to identify patients with ≥50% stenosis on QCA (57/98): 96%, 37%, 67% and 88%; compared to XECG: 71%, 76%, 80% and 66%. Quantitative CTA slightly overestimated diameter stenosis: 6±21% (R=0.71), compared to QCA. Of the 312 patients (66%) with a negative CTA, 44 (14%) had a positive XECG, but only 2/17 that underwent catheter angiography had significant CAD.

                      Conclusion: CTA is feasible and diagnostic in more patients compared to XECG. For interpretable studies, CTA has a higher sensitivity, but lower specificity for detection of CAD.

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