Multislice Computed Tomography in an Asymptomatic High-Risk Population

doi:10.1016/j.amjcard.2006.08.029

The American Journal of Cardiology

Volume 99, Issue 3, 1 February 2007, Pages 325-328

https://doi.org/10.1016/j.amjcard.2006.08.029 Get rights and content

Approximately 50% of all acute coronary syndromes occur in previously asymptomatic patients. This study evaluated the value of multislice computed tomography for early detection of significant coronary artery disease (CAD) in high-risk asymptomatic subjects. One hundred sixty-eight asymptomatic subjects with ≥1 major risk factor (hypertension, diabetes, hypercholesterolemia, family history, or smoking) and an inconclusive or unfeasible noninvasive stress test result (stress electrocardiography, echocardiography, or nuclear scintigraphy) were evaluated in an outpatient setting. After clinical examination and laboratory risk analysis, all patients underwent multislice computed tomographic (MSCT) coronary angiography within 1 week. In all subjects, conventional coronary angiography was also carried out. Multislice computed tomography displayed single-vessel CAD in 16% of patients, 2-vessel CAD in 7%, and 3-vessel CAD in 4%. Selective coronary angiography confirmed the results of multislice computed tomography in 99% of all patients. Sensitivity and specificity of MSCT coronary angiography were 100% and 98%, respectively, with a positive predictive value of 95% and a negative predictive value of 100%. In conclusion, MSCT coronary angiography is an excellent noninvasive technique for early identification of significant CAD in high-risk asymptomatic patients with inconclusive or unfeasible noninvasive stress test results.

Section snippets

Patient population

We enrolled 168 consecutive asymptomatic subjects from June 2004 to April 2005 (89 men, 27 women; mean age 60 ± 7 years, range 36 to 70) who were evaluated in a primary prevention program in an outpatient setting. All subjects were evaluated with clinical examination and laboratory risk analysis. Criteria for inclusion in this study were an age <70 years, absence of a previous diagnosis or symptoms of CAD (such as chest pain), presence of ≥1 CAD risk factor, and an inconclusive or unfeasible

Results

Multislice computed tomography showed no significant CAD in 73% of patients but identified significant 1-vessel disease in 16% of patients, 2-vessel disease in 7%, and 3-vessel disease in 4%. Four patients had significant left main CAD, and these patients were classified as having 2-vessel disease. Disease in the proximal left anterior descending coronary artery was identified in 5 patients (3%).

Selective coronary angiography confirmed the results of multislice computed tomography in 99% of all

Discussion

It is common experience that conventional stress tests, such as exercise electrocardiography, stress echocardiography, and nuclear scintigraphy, are often not feasible or equivocal. For these reasons, we examined the value of MSCT angiography in this patient population.

This study shows that multislice computed tomography can define significant CAD in high-risk asymptomatic patients with CAD risk factors and an inconclusive or unfeasible stress test result by noninvasive means. Overall accuracy

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Coronary artery diseaseMultislice Computed Tomography in an Asymptomatic High-Risk Population

Section snippets

Patient population

Results

Discussion

J Am Coll Cardiol

Am J Cardiol

Cardiol Clin

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Non-invasive coronary angiography with high resolution multidetector-row computed tomography: results in 102 patients

Eur Heart J

Coronary artery disease
Multislice Computed Tomography in an Asymptomatic High-Risk Population