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European Heart Journal Advance Access originally published online on June 23, 2008
European Heart Journal 2008 29(16):2006-2013; doi:10.1093/eurheartj/ehn284
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Multi-slice computed tomography coronary angiography for ruling out suspected coronary artery disease: what is the prevalence of a normal study in a general clinical population?

Maureen M. Henneman1, Joanne D. Schuijf1,2, Jacob M. van Werkhoven1, Gabija Pundziute1, Ernst E. van der Wall1,2, J. Wouter Jukema1,2 and Jeroen J. Bax1,*

1 Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, PO 9600, 2300 RC Leiden, The Netherlands
2 The Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands

Received 12 November 2007; revised 25 April 2008; accepted 5 June 2008; online publish-ahead-of-print 23 June 2008.

* Corresponding author. Tel: +31 71 5262020, Fax: +31 71 5266809, Email: j.j.bax{at}lumc.nl

Aims: To assess the prevalence of a normal multi-slice computed tomography (MSCT) in patients with suspected coronary artery disease (CAD) and to relate these observations to clinical presentation and pre-test likelihood of CAD.

Methods and results: In total, 340 consecutive patients (182 men, 55 ± 12 years) without a history of CAD who were referred for MSCT angiography were included in the study. Based on patient characteristics and the referral reason for MSCT angiography, patients were classified as having a low, intermediate, or high pre-test likelihood of CAD. Patients were evaluated for the presence of coronary artery calcium as well as the presence of atherosclerosis. Overall, 157 (46%) patients did not have coronary artery calcium and 133 (40%) patients had a completely normal MSCT angiogram. In 58% of the patients with low pre-test likelihood, no coronary atherosclerosis was observed when compared with 33 and 17% of the patients with intermediate and high pre-test likelihood, respectively.

Conclusion: MSCT ruled out coronary atherosclerosis in 40–46% of patients without known CAD who were referred for MSCT. Accordingly, in patients with low-to-intermediate pre-test likelihood, MSCT may be an attractive modality to exclude coronary atherosclerosis and may prevent unnecessary additional functional testing or invasive angiography.

Key Words: MSCT • Coronary artery disease • Coronary artery calcium score


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