64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease

Objectives We assessed the usefulness of 64-slice computed tomography coronary anglography (CTCA) to detect or rule out coronary artery disease (CAD) in patients with various estimated pretest probabilities of CAD. Background The pretest probability of the presence of CAD may impact the diagnostic performance of CTCA. Methods Sixty-four-slice CTCA (Sensation 64, Siemens, Forchheim, Germany) was performed in 254 symptomatic patients. Patients with heart rates >= 65 beats/min received beta-blockers before CTCA. The pretest probability for significant CAD was estimated by type of chest discomfort, age, gender, and traditional risk factors and defined as high (>= 71%), intermediate (31% to 70%), and low ( <= 530%). Significant CAD was defined as the presence of at least 1 >= 50% coronary stenosis on quantitative coronary angiography, which was the standard of reference. No coronary segments were excluded from analysis. Results The estimated pretest probability of CAD in the high (n = 105), intermediate (n = 83), and low (n = 66) groups was 87%, 53%, and 13%, respectively. The diagnostic performance of the computed tomography (CT) scan was different in the 3 subgroups. The estimated post-test probability of the presence of significant CAD after a negative CT scan was 17%, 0%, and 0% and after a positive CT scan was 96%, 88%, and 68%, respectively. Conclusions Computed tomography coronary angiography is useful in symptomatic patients with a low or intermediate estimated pretest probability of having significant CAD, and a negative CT scan reliably rules out the presence of significant CAD. Computed tomography coronary angiography does not provide additional relevant diagnostic information in symptomatic patients with a high estimated pretest probability of CAD.