Nico R. Mollet MD, Presenter: Nothing to Disclose

Willem B. Meijboom MD, Abstract Co-Author: Nothing to Disclose

Annick Carine Weustink MD, Abstract Co-Author: Nothing to Disclose

Carlos van Mieghem MD, Abstract Co-Author: Nothing to Disclose

Niels Van Pelt, Abstract Co-Author: Nothing to Disclose

Francesca Pugliese MD, Abstract Co-Author: Nothing to Disclose

Gabriel P. Krestin MD, PhD, Abstract Co-Author: Consultant, General Electric Company

Pim J. De Feyter MD, PhD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

The pre-test probability of the presence of significant CAD may impact on the diagnostic accuracy of CTCA. We assessed the clinical usefulness of 64-slice CT coronary angiography (CTCA) to detect or rule out significant coronary artery disease (CAD) in patients with various pre-test probabilities.

64-slice CTCA (Siemens Sensation 64, Germany) was performed in 302 symptomatic patients. Patients with heart rates ≥65 bpm received beta-blockers before CTCA.The pre-test probability for significant CAD was estimated by type of chest discomfort, age, gender, traditional risk factors and prior infarction and defined as high (≥71%), intermediate (31-70%) and low (≤30%). Significant CAD was defined as the presence of at least one ≥50% coronary stenosis on quantitative coronary angiography which was considered the standard of reference. No coronary segments were excluded from analysis.

The pre-test probability of significant CAD in the high (N:145), intermediate (N:91) and low (N:66) group was 89%, 53% and 13%, respectively. Positive and negative likelihood ratios for the high, intermediate and low pre-test probability group were 4.10, 6.75, 13.50 and 0.02, 0.00, and 0.00. The post-test probability of the presence of significant CAD after a negative CT scan was 14%, 0%, and 0%, and after a positive CT scan 97%, 88% and 68%.

CTCA is useful in symptomatic patients with a low or intermediate pre-test probability of having significant CAD, and a negative CT-scan reliably rules out the presence of significant CAD. CTCA does not provide additional relevant diagnostic information in symptomatic patients with a high pre-test probability of CAD.

CTCA is useful in symptomatic patients with a low or intermediate pre-test probability of having significant CAD, but is less useful in patients with a high pre-test probability for significant CAD.

Mollet, N, Meijboom, W, Weustink, A, van Mieghem, C, Van Pelt, N, Pugliese, F, Krestin, G, De Feyter, P, et al, , et al, , Sixty Four Slice Computed Tomography Coronary Angiography in Patients with High, Intermediate, or Low Pre-test Probability of Significant Coronary Artery Disease.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5010684.html