Non-significant Coronary Artery Disease Research Articles

Coronary Artery Atherosclerosis and Risk Stratification in Young Adults with an Intermediate Pretest Likelihood Detected by Multidetector Computed Tomography

To document the prevalence of coronary artery disease (CAD) and major adverse cardiac events (MACE) in patients younger than 45 years of age with intermediate pretest likelihood of CAD, and to determine whether coronary computed tomography angiography (cCTA) is useful for risk stratification of this cohort. We followed 452 intermediate pretest likelihood (according to Diamond and Forrester) outpatients who were suspected of CAD and underwent cCTA. They were all younger than 45 years old. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization. Follow-up was completed in 427 patients (94.5%) with a median follow-up period of 1081 days. No plaque was noted in 357 (83.6%) patients. Nonsignificant CAD was noted in 33 (7.7%) individuals and 37 (8.7%) patients with significant CAD. At the end of the follow-up period, 12 (2.8%) patients experienced MACE. The annualized event rate was 0.2% in patients with no plaque, 2.0% in patients with nonsignificant CAD, and 7.3% in patients with significant CAD. Hypertension, smoking, and significant CAD in cCTA were significant predictors of MACE in univariate analysis. Moreover, cCTA remained a predictor (P < .001) of events after multivariate correction (hazard ratio: 8.345, 95% CI: 3.438-17.823, P < .001). The prevalence of CAD and MACE in young adults with an intermediate pretest likelihood of CAD was considerable. cCTA is effective in restratifying patients into either a low or high posttest risk group. These results further emphasize the usefulness of cCTA in this cohort.

The Long-Term Effect of Coronary Stenting on Epicardial and Microvascular Endothelial Function

Coronary stents, drug-eluting stents in particular, have been linked to coronary epicardial endothelial dysfunction after implantation. However, less is known about their impact on coronary microvascular function and their long-term effects on the vasculature. We evaluated 71 patients (mean age, 53.0±10.1 years) with chest pain and angiographically nonsignificant coronary artery disease 17.1±17.1 months after left anterior descending coronary artery stenting. Seventy-one age- and sex-matched patients (mean age, 53.0±10.3 years) with chest pain but no prior coronary intervention served as controls. Coronary blood flow in response to the endothelium-dependent vasodilator acetylcholine as well as the microvascular (endothelium-independent) coronary flow reserve in response to intracoronary adenosine were evaluated. Quantitative coronary angiography was used to study epicardial diameter changes to acetylcholine. Microcirculatory function was not significantly different between the stenting and control groups (median [interquartile range] coronary flow reserve, 2.9 [2.5-3.4] versus 3.0 [2.4-3.4] mL/min, P=0.24; change of coronary blood flow, 34.9% [-34.4% to 90.0%] versus 54.7% [-5.6% to 104.6%], P=0.18). Both groups exhibited epicardial endothelial dysfunction (-23.0% [-47.4% to -7.6%] versus -20.0% [-40.0% to 0.0%], P=0.4). Results did not differ between patients with drug-eluting stents (n=46) and patients with bare-metal stents (n=24). This study demonstrates that in patients with coronary arteries in which a stent has been placed, coronary microcirculatory and epicardial vascular function are not significantly different from that of an age- and sex-matched population with similar symptoms but nonsignificant coronary artery disease.

Role of CTCA in Acute Coronary Syndrome—Predicting Non-Significant Coronary Artery Disease

Results: No significant differences were observed in all variables between EPA-treated (n= 12) and controls (n= 11) before EPA treatment. After three months of EPA treatment, ratio of plasma levels of EPA to arachidonic acid (AA) in the EPA-treated group were significantly higher than those in the control group (p= 0.009) (Table 1). There were no significant changes in plasma levels of glucose, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, or C-reactive protein in both groups. Plasma adiponectin levels increased significantly (p= 0.048) after EPA treatment. No statistically significant changes were obtained in plasma levels of visfatin (p= 0.175) or leptin concentrations (p= 0.152). Conclusion: These results indicated that EPA had an adiponectin-dependent anti-atherosclerotic effect. EPA are, therefore, thought to be beneficial in preventing vascular complications in patients with hyperlipidaemia.

Non-invasive computed tomography coronary angiography as a gatekeeper for invasive coronary angiography

To determine the rate of subsequent invasive coronary angiography (ICA) and revascularization in relation to computed tomography coronary angiography (CTA) results. In addition, independent determinants of subsequent ICA and revascularization were evaluated. CTA studies were performed using a 64-row (n = 413) or 320-row (n = 224) multidetector scanner. The presence and severity of CAD were determined on CTA. Following CTA, patients were followed up for 1 year for the occurrence of ICA and revascularization. A total of 637 patients (296 male, 56 ± 12 years) were enrolled and 578 CTA investigations were available for analysis. In patients with significant CAD on CTA, subsequent ICA rate was 76 %. Among patients with non-significant CAD on CTA, subsequent ICA rate was 20 % and among patients with normal CTA results, subsequent ICA rate was 5.7 % (p < 0.001). Of patients with significant CAD on CTA, revascularization rate was 47 %, as compared to a revascularization rate of 0.6 % in patients with non-significant CAD on CTA and no revascularizations in patients with a normal CTA results (p < 0.001). Significant CAD on CTA and significant three-vessel or left main disease on CTA were identified as the strongest independent predictors of ICA and revascularization. CTA results are strong and independent determinants of subsequent ICA and revascularization. Consequently, CTA has the potential to serve as a gatekeeper for ICA to identify patients who are most likely to benefit from revascularization and exclude patients who can safely avoid ICA.

25 hydroxyvitamin D levels in patients undergoing coronary artery catheterization

IntroductionA growing body of evidence suggests that vitamin D deficiency is associated with increased cardiovascular morbidity and mortality. The present study assessed the association between low serum 25-hydroxyvitamin D (25(OH)D) and coronary artery disease status defined by coronary catheterization findings. MethodsAn observational study of 101 consecutive patients admitted to Assaf Harofeh Medical Center during 2009, and scheduled to undergo coronary catheterization was undertaken. Blood was collected for parathyroid hormone, 25(OH)D and high sensitivity C reactive protein (hsCRP). 25(OH)D deficiency was defined as <20ng/ml. Patients were divided into two groups: patients with normal or non-significant coronary artery disease and patients with a significant coronary artery disease as found during cardiac catheterization. Logistic regression model was used to compare pathological coronary catheterization findings, including 25(OH)D levels dichotomized to low (serum 25(OH)D levels<20ng/ml) vs. high (serum 25(OH)D levels≥20ng/ml) and other confounders. ResultsPatients with pathological coronary catheterization had 25(OH)D deficiency (75% vs 55.1%, p=0.036). Pathological coronary catheterization was more prevalent among patients with 25(OH)D deficiency (Odds ratio (OR) 2.44, 95% confidence interval (CI) 1.05–5.68, p=0.038). This difference was more pronounced after controlling for sex, age, BMI, ethnicity and present smoking (OR 2.92, 95% CI 1.01–8.46, p=0.016). Conclusions25(OH)D deficiency is significantly associated with pathological cardiac catheterization findings. This association is strengthened further by controlling for other cardiovascular disease risk factors.

Prediction of Cardiovascular Events by Inflammatory Markers in Patients Undergoing Carotid Stenting

Objective To assess whether inflammatory markers predict atherosclerotic disease activity after carotid treatment in patients with severe carotid stenosis and nonsignificant coronary artery disease undergoing carotid stenting. Patients and Methods From March 1, 2004, to September 30, 2005, a total of 55 consecutive patients (mean ± SD age, 69±8.3 years; 26 men) with severe carotid stenosis and nonsignificant coronary artery disease were treated with carotid stent implantation. Patients were followed up for a period of 5 years for the occurrence of cardiovascular events. Results A significant correlation between quantitative analysis of debris entrapped in the filters and inflammatory markers was found. Moreover, the number of particles per filter, the total particles area, and the mean particle axis per filter were significantly higher in patients with clinical events at the follow-up compared with patients without events (87 vs 32, P=.006; 50,118.7 vs 17,782, P=.002; 33.9 vs 30.2, P=.03). At 5-year follow-up we recorded cardiovascular or neurologic events in 11 of the 55 patients (20%). Higher preprocedural levels of high-sensitivity C-reactive protein, interleukin 6 soluble receptor, and interleukin 6 were significantly associated with clinical events at follow-up ( P<.001, P=.05, and P=.02, respectively). In particular high-sensitivity C-reactive protein measured at 24 and 48 hours after carotid stenting showed a significant correlation with clinical events ( P=.001). Also preprocedural intracellular adhesion molecule 1 and circulating vascular cell adhesion molecule 1 blood concentrations were significantly correlated with a worse prognosis at follow-up ( P=.04 and P=.03, respectively). Conclusion In patients with severe carotid stenosis and nonsignificant coronary artery disease, inflammation is associated with atherosclerotic disease activity and a worse prognosis. Interleukin 6, interleukin 6 soluble receptor, intracellular adhesion molecule 1, vascular cell adhesion molecule 1, and high-sensitivity C-reactive protein levels at baseline and 24 and 48 hours after carotid stenting are predictive of neurologic and cardiovascular events at follow-up.

Age- and gender-specific differences in the prognostic value of CT coronary angiography

ObjectiveTo evaluate the potential age- and gender-specific differences in the incidence and prognostic value of coronary artery disease (CAD) in patients undergoing CT coronary angiography (CTA).Design and patientsIn this multicentre...

Prognostic value of Morise clinical score, calcium score and computed tomography coronary angiography in patients with suspected or known coronary artery disease

Our aim was to determine the prognostic value of computed tomography coronary angiography (CTCA), coronary artery calcium scoring (CACS) and Morise clinical score in patients with known or suspected coronary artery disease (CAD). A total of 722 patients (480 men; 62.7±10.9 years) who were referred for further cardiac evaluation underwent CACS and contrast-enhanced CTCA to evaluate the presence and severity of CAD. Of these, 511 (71%) patients were without previous history of CAD. Patients were stratified according to the Morise clinical score (low, intermediate, high), to CACS (0-10, 11-100, 101-400, 401-1,000, >1,000) and to CTCA (absence of CAD, nonsignificant CAD, obstructive CAD). Patients were followed up for the occurrence of major events: cardiac death, nonfatal myocardial infarction, unstable angina and revascularisation. Significant CAD (>50% luminal narrowing) was detected in 260 (36%) patients; nonsignificant CAD (<50% luminal narrowing) in 250 (35%) and absence of CAD in 212 (29%). During a mean follow-up of 20±4 months, 116 events (21 hard) occurred. In patients with normal coronary arteries on CTCA, the major event rate was 0% vs. 1.7% in patients with nonsignificant CAD and 7.3% in patients with significant CAD (p<0.0001). Three hard events (14%) occurred in patients with CACS≤100 and two (9.5%) in patients with intermediate Morise score; one revascularisation was observed in a patient with low Morise score. At multivariate analysis, diabetes, obstructive CAD and CACS >1,000 were significant predictors of events (p<0.05). An excellent prognosis was noted in patients with a normal CTCA (0% event rate). CACS ≤100 and low-intermediate Morise score did not exclude the possibility of events at follow-up.

Performance and efficacy of 320-row computed tomography coronary angiography in patients presenting with acute chest pain: results from a clinical registry

The purpose of this study was to evaluate the performance of 320-row computed tomography angiography (CTA) in the identification of significant coronary artery disease (CAD) in patients presenting with acute chest pain and to examine the relation to outcome during follow-up. A total of 106 patients with acute chest pain underwent CTA to evaluate presence of CAD. Each CTA was classified as: normal, non-significant CAD (<50% luminal narrowing) and significant CAD (≥50% luminal narrowing). CTA results were compared with quantitative coronary angiography. After discharge, the following cardiovascular events were recorded: cardiac death, non-fatal infarction, and unstable angina requiring revascularization. Among the 106 patients, 23 patients (22%) had a normal CTA, 19 patients (18%) had non-significant CAD on CTA, 59 patients (55%) had significant CAD on CTA, and 5 patients (5%) had non-diagnostic image quality. In total, 16 patients (15%) were immediately discharged after normal CTA and 90 patients (85%) underwent invasive coronary angiography. Sensitivity, specificity, and positive and negative predictive values to detect significant CAD on CTA were 100, 87, 93, and 100%, respectively. During mean follow-up of 13.7 months, no cardiovascular events occurred in patients with a normal CTA examination. In patients with non-significant CAD on CTA, no cardiac death or myocardial infarctions occurred and only 1 patient underwent revascularization due to unstable angina. In patients presenting with acute chest pain, an excellent clinical performance for the non-invasive assessment of significant CAD was demonstrated using CTA. Importantly, normal or non-significant CAD on CTA predicted a low rate of adverse cardiovascular events and favorable outcome during follow-up.

Transmural myocardial ischaemia complicating recovery after dobutamine-atropine stress echocardiography in patients with non-significant coronary artery disease: insights from invasive assessment of coronary physiology

In the proposed selection of cases, traditional imaging is integrated with contemporary diagnostic tools available in the cath-lab to navigate the potential mechanisms underlying a very rare complication occurring in the recovery phase of dobutamine-atropine stress echocardiography. The data, collected in a time frame of nearly 15 years, provide interesting elements to possibly evolve from speculative considerations to plausible confirmation of the candidate pathophysiological mechanism mediating the occurrence of transmural myocardial ischaemia after beta-blockers administration.

131 Tomography angiography in acute coronary syndrom: The TIACS study

Triage of chest pain patients in the emergency department remains challenging. Multi-slice computed tomography angiography (CTA) has a high negative predictive value for exclusion of coronary artery stenosis. to assess mid-term outcomes in patients with low to intermediate likelihood of acute coronary syndrome (ACS) who underwent Multi-slice CTA. prospective observational single-center cohort study in chest pain patients with normal troponin and non ischemic electrocardiogram. Patients with normal coronary 64-slice CTA or with stenosis less than 50% luminal narrowing were discharged from the emergency unit. End points were coronary artery revascularizations during index hospitalization and major adverse cardiac events (MACE) during follow-up. Among 123 patients (mean age 51 +/− 13 years, 70% men), 60 were free of coronary artery disease (CAD) according to CTA (49%). Twentysix (21%) had non obstructive disease and 29 (24%) had inconclusive or positive computed tomography for significant stenosis. Mean radiation exposure was 21 +/− 1 mSv. Twenty-seven patients had invasive coronary angiography. Ten patients (8%) needed coronary artery revascularizations during index hospitalization. Nine had coronary angioplasty and one patient had bypass surgery with four grafts. During the mean follow-up of 14+/-4 months, no patient suffered from MACE including patients who had coronary artery revascularizations during index hospitalization. Negative predictive value for MACE was 100% (95%confident interval 98–100%). Seventy-three percent of patients with acute chest pain and low to intermediate likelihood of ACS were free or had non-significant CAD according to CTA and no MACE during a 14 month follow-up period. Given the large number of such patients, early coronary CTA may significantly improve patients’ management in the emergency department. Reduction of radiation exposure will facilitate acceptance in clinical practice.

007 Impact of the use of fractional flow reserve (FFR) on the coronary revascularization strategy: insights from a large French multicenter FFR Registry (R3F)

Recent data suggest that fractional flow reserve (FFR) is useful in guiding coronary revascularization. There is however currently no large report of the use of this technology in France, in particular its impact on the decision of coronary revascularization. The R3F registry investigated the use of FFR in 20 French centers from October 2008 to June 2010. To investigate this issue the investigators defined prospectively their revascularization strategy “a priori” before performing the FFR. This was compared to the final strategy applied to the patient after performing the FFR. The results of the first 945 consecutive patients are presented. 75% of patients were males with a mean age of 65 ± 10 years, 37% were diabetics and 19% had a recent ACS. Patients had non-significant (< 50% stenosis) angiographic coronary artery disease (14%), significant (>50%) angiographic 1-vessel (37%), 2-vessel (30%) or 3-vessel disease (19%). The strategy defined “a-priori” by the investigators was medical therapy (52%), PCI (37%), and CABG (11%). After the results of FFR the final strategy was medical therapy in 58% and coronary revascularization in 42% (PCI in 31% and CABG in 11%). Interestingly in 45% of cases the strategy defined “a priori” was modified by the results of the FFR: 1) In 36% of the patients in which a medical therapy was planed “a priori” the strategy was modified for PCI (26%) or CABG (10%); 2) In 58% of the patients in which a PCI was considered “a priori” the strategy was modified for medical therapy (50%) or CABG (8%); 3) In 68% of the patients in which a CABG was considered “a priori” the strategy was modified for medical therapy (64%) or PCI (4%). The present report, based on a large French multicenter registry, demonstrated that although FFR had little impact on the overall rate of revascularization, it modified the individual decision in almost 1 out of 2 patients.

Non-Invasive Diagnostic Workup of Patients With Suspected Stable Angina by Combined Computed Tomography Coronary Angiography and Magnetic Resonance Perfusion Imaging

To evaluate additional adenosine magnetic resonance perfusion (MRP) imaging in the diagnostic workup of patients with suspected stable angina with computed tomography coronary angiography (CTCA) as first-line diagnostic modality. Two hundred and thirty symptomatic patients (male, 52%; age, 56 year) with suspected stable angina underwent CTCA. In patients with a stenosis of >50% as visually assessed, MRP was performed and the quantitative myocardial perfusion reserve index (MPRI) was calculated. Coronary flow reserve (CFR) using invasive coronary flow measurements served as the standard of reference. CTCA showed non-significant CAD in 151/230 (66%) patients and significant CAD in 79/230 patients (34%), of whom 50 subsequently underwent MRP and CFR. MRP showed reduced perfusion in 32 patients (64%), which was confirmed by CFR in 27 (84%). All 18 cases of normal MRP (36%) were confirmed by CFR. The positive likelihood ratio of MRP for the presence of functional significant disease in patients with a lesion on CTCA was 4.49 (95% confidence interval [CI] 2.12-9.99). The negative likelihood ratio was 0.05 (95%CI 0.01-0.34). CTCA as first-line diagnostic modality excluded coronary artery disease in a high percentage of patients referred for diagnostic workup of suspected stable angina. MRP made a significant contribution to the detection of functional significant lesions in patients with a positive CTCA.

Clinical Predictors of Stress‐Induced Transient Left Ventricular Dilatation in Patients With Nonsignificant Coronary Disease

Left ventricular transient dilatation (TD) during stress myocardial perfusion imaging has been associated with extensive and severe coronary artery disease (CAD). The authors investigated the clinical predictors of TD in patients with nonsignificant CAD. The authors retrospectively studied 134 consecutive patients with exercise (n=59) or dipyridamole (n=75) stress-induced TD who had undergone coronary angiography within 6 months of the test. Significant CAD was defined as diameter stenosis ≥70% in at least one major coronary artery, and significant left main disease as >50% diameter stenosis. Angiographically-significant CAD was found in 126 patients (94%), and nonsignificant CAD in the remaining 8 patients (6%). No differences in gender, history of smoking, hyperlipidemia, family history of CAD, body mass index, and left ventricular ejection fraction were found between patients with significant and nonsignificant CAD. All 8 nonsignificant CAD patients had a history of either hypertension (7/8) or electrocardiographic criteria for left ventricular hypertrophy (1/8), compared with 58% of the hypertensive patients in the significant CAD group (P=.02). Nonsignificant CAD patients were also characterized by lack of diabetes mellitus (P=.05) or prior myocardial infarction (P=.05). Hypertension seems to be an important clinical predictor of TD in patients with nonsignificant CAD.

Phase-sensitive black-blood coronary vessel wall imaging

Black-blood MR coronary vessel wall imaging may become a powerful tool for the quantitative and noninvasive assessment of atherosclerosis and positive arterial remodeling. Although dual-inversion recovery is currently the gold standard, optimal lumen-to-vessel wall contrast is sometimes difficult to obtain, and the time window available for imaging is limited due to competing requirements between blood signal nulling time and period of minimal myocardial motion. Further, atherosclerosis is a spatially heterogeneous disease, and imaging at multiple anatomic levels of the coronary circulation is mandatory. However, this requirement of enhanced volumetric coverage comes at the expense of scanning time. Phase-sensitive inversion recovery has shown to be very valuable for enhancing tissue-tissue contrast and for making inversion recovery imaging less sensitive to tissue signal nulling time. This work enables multislice black-blood coronary vessel wall imaging in a single breath hold by extending phase-sensitive inversion recovery to phase-sensitive dual-inversion recovery, by combining it with spiral imaging and yet relaxing constraints related to blood signal nulling time and period of minimal myocardial motion.

Prevalence and impact of coronary artery disease in idiopathic pulmonary fibrosis

Idiopathic Pulmonary Fibrosis (IPF) is a progressive disease with a poor prognosis for which there is no effective medical therapy. An awareness of comorbidities that are treatable and might impact outcomes in these patients is therefore very important. We sought to determine the prevalence of coronary artery disease (CAD) in IPF patients in comparison to a control group of patients with chronic obstructive pulmonary disease (COPD). We also sought to assess the impact of CAD on IPF patient outcomes. IPF and COPD transplant candidates whose work-up included left heart catheterization were categorized as having significant CAD, non-significant CAD or no disease. The risk factor profile and prevalence of CAD in both groups was compared. There were 73 IPF and 56 COPD patients. The prevalence of CAD was 65.8% in the IPF group compared to 46.1% in the COPD patients (p<0.028). Significant disease was present in 28.8% of IPF patients vs.16.1% of the COPD patients (p<0.081). Unsuspected significant CAD was found in 18% of IPF patients versus 10.9% of COPD patients (p<0.004). Outcomes of IPF patients with significant CAD was worse than those with no or non-significant disease (p<0.003) with a median survival of 572 days from the time of left heart catheterization. There is a higher prevalence of CAD in IPF patients compared to a similarly matched COPD group. This increased association appeared to be independent of common coronary artery risk factors. IPF patients with significant CAD appear to have worse outcomes.

What is the Clinical Relevance of Pericardial Effusion Reported on Chest Computed Tomography Performed for General Indications in a Tertiary Hospital? A Comparison With Transthoracic Echocardiography

low ( 20%) and very high risk (>40%). Results: During follow-up (mean 2.3± 1 years), 57 patients suffered an event. The annualized event rate for patients with a normal CTA (n= 514, 36%) was 0.6%, 1.3% for non-significant CAD (n= 483, 34%) and 3.7% for significant CAD (442, 31%). In patients with a CAP-CT risk score 16 (n= 242, 17%). The CAP-CT risk score reclassified 287(20%) patients with non-significant or significant CAD to a lower risk group, and 443(31%) to a higher risk group. Conclusion: The integration of plaque extent, severity, composition and location on CTA into a single risk model provides good discrimination between low, high and very high risk for future cardiovascular events, compared to conventional CTA classification. doi:10.1016/j.hlc.2010.06.494

Computed tomography coronary angiography plaque burden in patients with suspected coronary artery disease

To determine the relationship between established cardiovascular risk factors, clinical presentation and the extent of coronary artery disease (CAD), as described with computed tomography coronary angiography. In this cross-sectional study, we included 567 symptomatic individuals without a history of CAD who consecutively underwent 64-slice computed tomography coronary angiography for evaluation of suspected CAD. We analyzed the prevalence of CAD depending on sex, age, symptoms and risk factors. A total of 8542 segments were analyzed. No evidence of CAD was observed in 225 patients (40%), nonsignificant CAD in 221 patients (39%) and significant CAD (luminal narrowing >50%) in the remaining 121 patients (21%). CAD increased with advancing age, significantly above 50 years (P < 0.05). Female patients had a higher prevalence of normal coronary arteries and males of significant CAD (P < 0.01). With the increase of risk factors, there was a significant increase of the significant disease (P < 0.01). Typical pain with respect to atypical pain had the strongest association with significant CAD (16 vs. 38%; P < 0.05). In multivariate analysis, the number of risk factors, age, male sex and typical pain remained strong predictors of significant CAD (P < 0.0001). Computed tomography coronary angiography may play an important role in risk stratification of patients with suspected CAD.

128-Detector-Row Computed Tomography Coronary Angiography Evaluating Coronary Artery Disease: Who Avoids Cardiac Catheterization?

To evaluate the prevalence of significant coronary artery disease (CAD) and nondiagnostic studies in patients referred for clinically indicated coronary angiography performed by 128 multidetector computed tomography (MDCT). We examined patients referred for coronary computed tomography (CT) angiography for the presence of CAD. The analysis included 438 studies classified as normal, with nonsignificant CAD, with significant CAD, or nondiagnostic. Of the 438 cases evaluated, 121 (27.6%) cases were reported as normal, 184 (42%) were classified as nonsignificant CAD, 92 (21%) as significant CAD, and 41 (9.3%) were inconclusive. Therefore, 69.7% of the study population most probably did not require conventional coronary angiography. Among patients referred for computed tomography angiography (CTA) for appropriate indications, 69.6% had either normal coronary arteries or nonobstructive disease. Given the high negative predictive value of coronary CTA, these patients most likely would not require invasive coronary angiography. Selective cardiac CTA may substantially decrease unnecessary diagnostic cardiac catheterizations.

Multislice computed tomography coronary angiography for risk stratification in patients with an intermediate pretest likelihood

Objectives:To assess whether multislice computed tomography coronary angiography (MSCTA) may be useful for risk stratification of patients with suspected coronary artery disease (CAD) at intermediate pretest likelihood according to Diamond...