European Heart Journal Advance Access published online on March 9, 2007
European Heart Journal, doi:10.1093/eurheartj/ehl563
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Adjunctive value of CT coronary angiography in the diagnostic work-up of patients with typical angina pectoris
1 Erasmus Medical Center, Departments of Cardiology, Room Ca-228a, Dr Molewaterplein 40, Rotterdam 3000CA, The Netherlands
2 Erasmus Medical Center, Departments of Radiology, Rotterdam, The Netherlands
3 Ikazia Hospital, Department of Cardiology, Rotterdam, The Netherlands
Received 7 July 2005; revised 19 January 2007; accepted 1 February 2007.
* Corresponding author. Tel: +31 10 463 5071; fax: +31 10 463 4320. E-mail address: n.mollet{at}erasmusmc.nl
Aims: To determine the adjunctive value of CT coronary angiography (CTCA) in the diagnostic work-up of patients with typical angina pectoris.
Methods and results: CTCA was performed in 62 consecutive patients (45 male, mean age 58.8 ± 7.7 years) with typical angina undergoing diagnostic work-up including exercise-ECG and conventional coronary angiography. Only patients with sinus heart rhythm and ability to breath hold for 20 s were included. Patients with initial heart rates 
70 beats/min received ß-blockers. We determined the post-test likelihood ratios, to detect or exclude patients with significant (50% lumen diameter reduction) stenoses, of exercise-ECG and CTCA separately, and of CT performed after exercise-ECG testing. The prevalence of patients with significant coronary artery disease (CAD) was 74%. Positive and negative likelihood ratios for exercise-ECG were 2.3 [95% confidence interval (CI): 1.0–5.3] and 0.3 (95% CI: 0.2–0.7) and for CTCA 7.5 (95% CI: 2.1–27.1) and 0.0 (95% CI: 0.0–8), respectively. CTCA increased the post-test probability of significant CAD after a negative exercise-ECG from 58 to 91%, and after a positive exercise-ECG from 89 to 99%, while CT correctly identified patients without CAD (probability 0%).
Conclusion: Non-invasive CTCA is a potentially useful tool, in the diagnostic work-up of patients with typical angina pectoris, both to detect and to exclude significant CAD.
Key Words: Imaging • Coronary artery disease • Computed tomography • Coronary angiography • Exercise-ECG test
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