Coronary artery disease: coronary MR angiography helped rule out clinically significant disease.

Clinical bottom line (level 1b)

  1. Over half of patients with suspected coronary artery disease referred for coronary angiography had it. One in six had clinically significant disease.
  2. A normal coronary magnetic resonance angiogram made clinically significant coronary artery disease unlikely (LR - 0.071) .
Kim et al: New Engl J Med 2001; 345 : 1863-1869
Expires March 2004

The study

Setting: 7 acute hospitals, Europe and USA

109 patients (aged 27 to 75; mean 59, 69% male) undergoing elective coronary angiography for suspected coronary artery disease within 14 days

Excluded if
  • previous X-ray coronary angiography, or thoracotomy
  • claustrophobia
  • orthopnoea
  • inability to take sublingual nitrates (e.g. aortic stenosis or obstructive cardiomyopathy)
  • aged < 21
  • not in sinus rhythm
  • weight > 100 kg
  • contraindication to MR imaging


Independent blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • X-ray coronary angiography: 50% or more stenosis
    • any coronary artery disease
    • clinically significant coronary artery disease: involving left main coronary artery or three-vessel disease
Diagnostic test: coronary magnetic resonance imaging

The evidence

pre-test probability of any coronary artery disease: 57%, (95% CI: 48% to 67%)
pre-test probability of severe coronary artery disease: 16%, (95% CI: 8.7% to 23%)

diagnostic test any coronary artery disease no coronary artery disease LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
coronary MR angiography 51 18 2.1
(1.5 to 3.0) 		74% 0.21
(0.099 to 0.43) 		22%
total 58 43


diagnostic test clinically significant coronary artery disease no clinically significant coronary artery disease LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
coronary MR angiography 15 10 8.0
(4.4 to 15) 		60% 0.071
(0.011 to 0.47) 		1%
total 16 85

Comments

  1. Mean total MR scanning time (including scout imaging) was 70 minutes (range 33 to 145)

Citation

  1. Kim WY, Danias PG, Stuber M, et al: coronary magnetic resonance angiography for the detection of coronary stenoses. New Engl J Med 2001; 345 : 1863-1869
Search Terms:
Contributor: Chris Ball, March 2002
Reviewer:

Clinical Question.
Patient suspected coronary artery disease undergoing elective angiography
Intervention or Exposure coronary magnetic resonance angiography
Outcome coronary artery disease