Author + information
- Edris Alderwish,
- Pamela Noack,
- Moshrik Abd Alamir and
- Michael Poon
Background: Stress testing and invasive coronary angiography (ICA) is often used to determine the clinical significance of obstructive lesions by CCTA.
Methods: From 1/2011 to 12/2015 our tertiary care center performed 7,011 CCTAs on low to intermediate risk patients with chest pain. We identified 737 consecutive cases of obstructive disease by CCTA and classified them as suspicious (>50% stenosis), moderate (50%-70% stenosis), and severe (>70% stenosis). We compared the clinical outcomes up to 30 days from the index visit and downstream testing among the three groups. Sensitivity and specificity were calculated for both CCTA and CCTA with stress testing.
Results: Stress testing was used more often in the moderate group (59.4%) followed by the suspicious (44.8%), and severe (17.5%) groups (p<0.000). The severe group had more ICA confirmed stenosis (73.8%), and higher rates of percutaneous (55.9%) and surgical intervention (8.7%) as compared with the suspicious group (15.5%, 12.9%, and 0.0% respectively) and the moderate group (0.8%, 0.8%, and 0% respectively). Sensitivity and specificity for CCTA was 98% and 87% respectively. Addition of stress testing decreased sensitivity (70%), but increased specificity (93%) of CCTA.
Conclusions: Patients with <70% stenosis by CCTA are generally safe to discharge with aggressive medical therapy and outpatient follow-up. Stress testing may be helpful only in cases for which quantifying obstruction is uncertain.
Moderated Poster Contributions
Non Invasive Imaging Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 12:30 p.m.-12:40 p.m.
Session Title: Which Test Is Best for Pain in the Chest?
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1317M-03
- 2017 American College of Cardiology Foundation