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Cardiac imaging and non-invasive testing
Computed tomography versus exercise electrocardiography in patients with stable chest complaints: real-world experiences from a fast-track chest pain clinic
  1. K Nieman1,2,
  2. T Galema1,
  3. A Weustink2,
  4. L Neefjes2,
  5. A Moelker2,
  6. P Musters1,
  7. R de Visser1,
  8. N Mollet2,
  9. H Boersma1,
  10. P J de Feijter1,2
  1. 1
    Erasmus Medical Centre, Department of Cardiology, Rotterdam, The Netherlands
  2. 2
    Erasmus Medical Centre, Department of Radiology, Rotterdam, The Netherlands
  1. Correspondence to Dr K Nieman, Erasmus Medical Centre, Thoraxcenter Bd 434, PO Box 2040, 3000 CA, Rotterdam, The Netherlands; Koennieman{at}


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, mean (SD) age 56 (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 an XECG. Clinically driven quantitative catheter angiography 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 (10.2%, p<0.001), and produced non-diagnostic results in 3 (0.7%) vs 140 (33%, p<0.001). CTA showed ⩾1 coronary stenosis (⩾50%) in 140 patients (30%), XECG was abnormal in 93 patients (33%). Results by CTA and XECG matched for 185 patients (68%, p = 0.63). Catheter angiography showed obstructive CAD in 57/98 patients (58%). Sensitivity, specificity, positive and negative predictive value of CTA to identify patients with ⩾50% stenosis was 96%, 37%, 67% and 88%, respectively; compared with XECG: 71%, 76%, 80% and 66%, respectively. Quantitative CTA slightly overestimated diameter stenosis: 6 (21)% (R = 0.71), compared with QCA. Of the 312 patients (66%) with a negative CTA, 44 (14%) had a positive XECG, but only 2/17 who underwent catheter angiography had significant CAD.

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

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  • Competing interests None declared.

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

  • Ethics approval Approved by the institutional review board of the Erasmus Medical Centre, Rotterdam, The Netherlands.