Anselmo Alessandro Palumbo MD, Abstract Co-Author: Nothing to Disclose

Filippo Cademartiri MD, PhD, Abstract Co-Author: Nothing to Disclose

Sara Seitun MD, Abstract Co-Author: Nothing to Disclose

Erica Maffei MD, Presenter: Nothing to Disclose

Teresa Arcadi MD, Abstract Co-Author: Nothing to Disclose

Chiara Martini RT, Abstract Co-Author: Nothing to Disclose

Alberto Clemente MD, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

to evaluate diagnostic accuracy of stress ECG and CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis using conventional coronary angiography (CAG) as the reference standard in the “real world”.

236 consecutive patients (159 males, 77 females, mean age 62.8±10.2 years) at intermediate risk with suspected coronary artery disease were enrolled for the study and underwent stress ECG, CT-CA and CAG. For the CT-CA scan (Sensation 64, Siemens, Germany) we administered an IV bolus of 100 ml of iodinated contrast material (Iomeprol 400 mgI/ml, Bracco, Italy). The reports of stress ECG and CT-CA were used to evaluate diagnostic accuracy as compared to CAG for the detection of significant stenosis at ≥50% for CT-CA.

16 patients were excluded from the analysis because of a non diagnostic quality of stress ECG and/or CT-CA. The prevalence of disease demonstrated at CAG was 62% (n. 220), 51% in the population with comparable stress ECG and CT-CA (n. 147), and 84% in the population with doubt stress ECG (n. 73). Seventy-three (33.2%) stress ECG were classified as doubt, 69 (31.4%) as positive, and 78 (35.5%) as negative. In per patient analysis diagnostic accuracy for stress ECG was: sensitivity 47%, specificity 53%, positive predictive value 51%, negative predictive value 49%. Forty (27.2%) patients were misclassified as negative. Thirty-four (23.1%) patients with non significat stenosis were overestimated as positive. Diagnostic accuracy of CT-CA was: sensitivity 96%, specificity 65%, positive predictive value 74%, negative predictive value 94%. Three (2%) patients were incorrectly classified as negative. Twenty-five (17%) were misclassified as positive. The difference in diagnostic accuracy between stress ECG and CT-CA was significant (p<0.01).

CT-CA in the real world has significantly higher diagnostic accuracy as compared to stress ECG and could be used instead in patients with intermediate risk.

In patients at intermediate risk/prevalence of disease, stress ECG has a very low diagnostic performance as compared to CT-CA using a real world approach.

Palumbo, A, Cademartiri, F, Seitun, S, Maffei, E, Arcadi, T, Martini, C, Clemente, A, et al, 0, Stress ECG vs CT Coronary Angiography for the Diagnosis of Coronary Artery Disease: A “Real-World" Experience  .  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8010649.html