ISCHAEMIC HEART DISEASE

How accurate is 16-slice MDCT at diagnosing obstructive coronary disease? ▸

Garcia et al enrolled 238 patients from 11 different hospitals over a nine month period; all had been referred for non-emergency coronary angiography. All patients underwent initial low-dose multidetector computed tomography (MDCT) to evaluate coronary artery calcium, and those with an Agatston score < 600 (187 patients) underwent contrast-enhanced MDCT. Both the MDCT studies and the patients’ subsequent angiograms were analysed by independent core laboratories. Of 1629 non-stented segments larger than 2 mm in diameter, 89 (5.5%) occurred in 59 (32%) of 187 patients with stenosis of more than 50% by conventional angiography. Of the 1629 segments, 71% were evaluable on MDCT. All non-evaluable segments were censored as positive, and this allowed a sensitivity for detecting more than 50% luminal stenosis to be calculated as 89%; specificity 65%; positive predictive value 13%; and negative predictive value 99%. Sensitivity for detecting more than 70% luminal stenosis was 94%; specificity 67%; positive predictive value 6%; and negative predictive value 99%. This study shows that MDCT coronary angiography performed with 16-row scanners is limited by a high number of non-evaluable cases and a high-false positive rate.

Migraine with aura as a risk factor for heart attacks ▸

Migraine with aura has been associated with an adverse cardiovascular risk profile and prothrombotic factors. An association with stroke has also been demonstrated, but an association with coronary events has not previously been shown. A prospective study of 27 840 American women aged over 45 years who were participating in the Women’s Health Study, and who were free of angina, was undertaken between 1992 and 2004. The primary outcome measure was the combined end point of major cardiovascular disease (first instance of non-fatal ischaemic stroke or myocardial infarction). At baseline, 5125 of the women (18.4%) reported any history of migraine; of the 3610 who had experienced at least …