Coronary CT Scanning superior to exercise testing (stress ECG) for evaluation of suspected coronary artery disease

Coronary CT Angiography superior to exercise testing for evaluation of suspected coronary artery disease By Reuters Health March 8, 2010 NEW YORK (Reuters Health), Mar 8 – Exercise testing is sensitive for coronary artery disease when ST-segment changes, angina, and hemodynamic variables are considered — but it’s still not as sensitive as computed tomographic angiography (CTA), a study from Denmark shows. Lead author Dr. Kristian A. Ovrehus, of Lillebaelt Hospital, Vejle, and colleagues compared three approaches: exercise testing and ST-segment changes alone; exercise testing with ST-segment changes, development of angina, and hemodynamic changes; or CTA. The authors defined an ST-segment change as any horizontal/descending ST depression or elevation greater than 0.1 mV measured more than 80 msec from the J-point. Positive CTAs showed a coronary lumen reduction of at least 50%. Of the total study cohort of 100 patients (50% men; mean age, 61), 18% had one-vessel disease, 5% had two-vessel disease, and 6% had three-vessel disease. The researchers report in the American Journal of Cardiology published online February 8 that using ST-segment changes only, exercise testing had a sensitivity of 45% and a specificity of 63%. With all variables included, the sensitivity rose to 72%, and the specificity fell to 37%. CTA, however, had a sensitivity of 97% and a specificity of 80%. “Previous reports on the diagnostic performance of exercise testing and coronary CT angiography indicate that these non-invasive diagnostic tests seem to perform differently in different patients cohorts,” Dr. Ovrehus told Reuters Health in an email. He noted that more prospective and large-scale trials are needed in order to delineate their relative diagnostic value. “Our next step research-wise is to look at the clinical consequences of the two noninvasive diagnostic strategies, i.e., their influence on additional downstream testing, cost, as well as on prognosis,” Dr. Ovrehus said. By Michelle Rizzo Am J Cardiol 2010. Last Updated: 2010-03-05 17:35:20 -0400 (Reuters Health)