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?

Abstract

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. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008.