TITLE:
How to Reduce Unnecessary Invasive Angiograms When Patients Are Initially Evaluated by Coronary Computed Tomography?
AUTHORS:
Edouard Cheneau, Brunot Vahda, Noémie Resseguier, Laurent Bernard, Annamaria Molon, Roch Giorgi, Dimitri Panagides
KEYWORDS:
Angina; Coronary Disease; Diagnosis; CCT
JOURNAL NAME:
Advances in Computed Tomography,
Vol.2 No.1,
March
5,
2013
ABSTRACT: Purpose:When Coronary Computed Tomography (CCT) detects coronary obstruction, patients are regularly referred to invasive angiogram. With higher sensitivity than specificity, CCT might induce unnecessary angiograms (“false positive CCT”). We sought to determine the patients and CCT findings associated with false positive CCT. Methods: Patients were prospectively referred to CCT with a 64-slice CT scan for suspected CAD. Inclusion criteria were: 1) clinically suspected angina pectoris; or 2) suspected silent ischemia on resting EKG. Exclusion criteria were acute coronary syndrome and non sinus rhythm. Invasive coronary angiogram (ICA) was performed on the basis of CCT findings (stenosis >50%). Analysis was performed on a per patient basis. Results: Out of 702 patients, 228 had suspected significant stenosis by CCT and ICA was performed in 176 patients. Coronary stenosis >50% was not confirmed by ICA in 44 (25%). In multivariate analysis, we observed that atypical angina (OR 3.63,CI 1.43-9.66), silent ischemia (OR 5.11, CI 1.89-14.6) and number of suspected stenosed arteries by CCT (OR 1.81, CI 1.15-2.94) were independently predictive of false positive CCT (p Conclusions:Performing CCT for atypical angina or silent ischemia is associated with higher rate of unnecessary invasive coronary angiograms. We failed to identify lesions characteristics prone to be “false positive” of CCT.