In patients with stable chest pain, CT is more often diagnostic than exercise ECG

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NEW YORK (Reuters Health), Nov 2 - Unlike exercise electrocardiography (XECG), CT angiography (CTA) is "nearly always" feasible and diagnostic in patients with stable chest complaints, researchers say in the October issue of the journal Heart.

While XECG is "a well-established and inexpensive procedure ... and has been in widespread clinical use for decades," this test "is also known for its modest diagnostic accuracy," Dr. Koen Nieman and colleagues from Erasmus Medical Center, Rotterdam, the Netherlands, write.

Another option, they continue, is 64-slice, dual-source multislice CT, which "has emerged as a diagnostic alternative in patients with suspected coronary artery disease (CAD)."

In their recent study, the researchers compared the diagnostic performance of the two tests in 471 symptomatic ambulatory patients.

According to their report, non-diagnostic or inconclusive results were seen in 0.7% of CT scans 33% of XECGs.

Overall, 30% of CT angiograms showed >50% stenosis in at least one vessel. Thirty-three percent of XECGs were abnormal. Results of CTA and XECG matched in 68% of patients with interpretable results.

Ninety-eight patients were selectively referred for catheter angiography, and obstructive CAD was found in 58%.

The sensitivity, specificity, and positive and negative predictive values of CTA for identifying patients with at least 50% stenosis were 96%, 37%, 67%, and 88%, respectively. For XECG, the corresponding values were 71%, 76%, 80%, and 66%.

"The results of this study have generated hypotheses for the use of CTA in patients with stable chest pain, which require testing in prospective, randomized trials," the authors conclude.

Heart 2009;95:1669-1675.

Last Updated: 2009-10-30 17:41:04 -0400 (Reuters Health)

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