Stratification for noninvasive coronary angiography: patient preselection considering atypical angina pectoris, conventional cardiovascular risk assessment, and calcium scoring
| Autor: | Thomas Butz, Wilhelm Koester-Eiserfunke, Frank van Buuren, Juergen Diekmann, Christoph Langer, Krista Franzke, Marcus Wiemer, Dieter Horstkotte, Andreas Peterschröder, K.-P. Mellwig |
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| Rok vydání: | 2009 |
| Předmět: |
Male
Coronary angiography medicine.medical_specialty Epidemiology Atypical Angina Coronary Artery Disease Coronary Angiography Risk Assessment Angina Pectoris Predictive Value of Tests Risk Factors Internal medicine medicine Humans Prospective Studies Aged Tomography Emission-Computed Single-Photon medicine.diagnostic_test business.industry Patient Selection Calcinosis Reproducibility of Results Magnetic resonance imaging Multislice computed tomography Middle Aged Invasive coronary angiography Calcium scoring Cardiovascular Diseases Cardiology Female Radiology Tomography X-Ray Computed Cardiology and Cardiovascular Medicine Risk assessment business Agatston score Magnetic Resonance Angiography |
| Zdroj: | European Journal of Cardiovascular Prevention & Rehabilitation. 16:201-209 |
| ISSN: | 1741-8267 |
| Popis: | Noninvasive coronary angiography (NCA) is recommended to be applied as a filter before invasive coronary angiography in patients with intermediate cardiovascular risk.In this prospective single-center study, we validated multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)-based NCA by primarily selecting patients with atypical angina pectoris (AAP).In 68 patients (63.6+/-11.4 years) with AAP, the Prospective Cardiovascular Muenster Study score and the Agatston score equivalent (ASE; calcium score) were initially determined for cardiovascular risk assessment. Subsequently, MSCT and MRI-based NCA were performed followed by quantitative invasive coronary angiography for validation. All tests were finally analyzed.CAD (prevalence 38.2%) was diagnosed in 67.7% of patients at high, 61.5% at intermediate, and 37.8% at low cardiovascular risk according to the Prospective Cardiovascular Muenster Study. CAD was diagnosed in 88.2% of patients with an ASEor=75th percentile and in 90.9% with an ASEor=90th percentile. With regard to NCA, patient-based analysis resulted in a sensitivity of 96.2% for MSCT versus 69.2% for MRI, in a specificity of 95.2 versus 64.3%, in a positive predictive value of 97.6 versus 77.1%, in a negative predictive value of 92.6 versus 54.5%, and a diagnostic accuracy of 95.6 versus 66.2% (P0.05).In a patient group with a heterogeneous cardiovascular risk, primarily considering AAP allows for effective patient preselection for NCA. This may be optimized by precluding patients with an ASEor=75th percentile. MSCT rather than MRI may then effectively be involved. |
| Databáze: | OpenAIRE |
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