Angina: no calcification on electron-beam CT helped rule out coronary artery disease

Clinical bottom line (level 1b)

Over half or patients with suspected coronary artery disease referred for cardiac catherisation had significant coronary artery disease (stenosis of 50% or more).
No calcification on electron-beam CT made significant stenosis unlikely (LR - 0.016) .

Harberl et al: J Am Coll Cardiol 2001; 37 : 451-457

Expires March 2004

The study

Setting: university hospital, Germany

1764 patients (aged 20 to 80; mean 57, 69% male) with suspected coronary artery disease (typical or atypical chest pain and/or signs of cardiac ischaemia on stress testing and a clinical indication for angiography)

Excluded if

known coronary artery disease
specifically referred for coronary artery interventions

Independent blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:

angiography perfomed within 30 days of electron-beam CT scan

Diagnostic test: electron-beam CT scan

The evidence

pre-test probability of significant coronary artery stenosis (50% or more): 56%, (95% CI: 54% to 59%)

diagnostic test	significant coronary artery stenosis	no significant stenosis	LR+ (95% CI)	post-test probability	LR- (95% CI)	post-test probability
EB-CT	935	490	1.5 (1.4 to 1.6)	66%	0.016 (0.0066 to 0.039)	2%
total	940	734

Citation

Harberl R, Becker A, Leber A, et al: correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1764 patients. J Am Coll Cardiol 2001; 37 : 451-457

Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, March 2002
Reviewer:

_{Clinical Question.}

_Patient	_{suspected coronary artery disease}
_{Intervention or Exposure}	_{electron-beam CT}
_Comparison	_angiography
_Outcome	_{coronary artery stenosis of 50% or more}