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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