MDCT helps exclude coronary artery stenosis

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The exclusion of coronary artery disease (CAD) through visualization by multidetector CT (MDCT) predicts an excellent long-term prognosis, according to a study presented at the American Heart Association conference this week in Orlando, Fla.

Peter Steinbigler, MD, and Ralph Haberl, MD, from the Klinikum Munich Pasing in Munich, Germany were the lead investigators of the study.

Before the study, the researchers hypothesized that the exclusion of CAD and/or the exclusion of non-obstructive plaques by MDCT would be able to determine a good long-term prognosis in patients with chest pain.

The scientists examined 1,017 consecutive patients for a MDCT because of chest pain. There were 657 males and 360 females with a mean age of 64. They used a Philips Medical Systems’ Brilliance CT system for the study.

The researchers excluded patients with troponine, positive acute coronary syndrome, stents, atrial fibrillation, untreated hyperthyroidism, kidney failure and a calcium score higher than 1,500.

The MDCT results of 372 patients, or 37 percent, with obstructive CAD and an average follow-up of 602 days were that 45 percent underwent an invasive procedure in less than 30 days and 31 percent underwent an invasive study after 30 days. In addition, 84 percent underwent percutaneous coronary intervention (PCI), 72 percent experienced stenosis and 3 percent died.

The MDCT results of 620 patients, or 63 percent, with no obstructive CAD and an average follow-up of 612 days were that 2 percent underwent an invasive procedure in less than 30 days and 8 percent underwent an invasive study after 30 days. In addition, no patients underwent PCI, 1 percent experienced stenosis, and 1 percent died.

The MDCT results for plaque detection for the entire cohort found that 498 patients had no plaque and no cardiac events, 361 had plaque and had no cardiac events, while 158 had plaque and had cardiac events.
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The researchers found that the exclusion of obstructive CAD by MDCT is possible at best with 64-slice scanners but also feasible with 4-, 16- and 40-slice scanners. Also, noninvasive coronary angiography by 64-slice CT was able to identify significant stenoses in patients with chest pain.